Purpose The treatment of acute anterior cruciate ligament (ACL) ruptures with a repair technique has recently regained interest. A novel ACL repair technique was described using Independent Suture Tape Reinforcement with 2-year follow-up results. Methods Forty-two consecutive patients with an acute ACL rupture undergoing repair using this technique were followed up for a minimum of 2 years. Patients with mid-substance, distal ACL ruptures, poor ACL tissue quality or retracted ACL remnants as well as patients with multi-ligament injuries were excluded. Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12 Item Health Survey (VR-12) and the Marx Activity scale were collected by online questionnaires. Two-year postoperative patients were asked by telephone if they had experienced a rerupture. Results All the KOOS subscales improved signiicantly in comparison to the preoperative score. The largest improvement of all scores was seen at 3 months postoperatively which is signiicant in all cases. The KOOS sport and recreation showed a meaningful change and the largest improvement of the KOOS subscales at 3 months postoperatively, as well as the highest total improvement at 1 year postoperatively compared to preoperatively. The VAS-pain and VR-12 physical score improved signiicantly, however the Marx activity scale decreased signiicantly in comparison to preoperative scores. Two patients reported a rerupture (4.8%, CI 1.7-11.2%). Conclusions This is the irst case series that described the 2-year follow-up results of patients with an acute, proximal ACL rupture, treated with the Independent Suture Tape Reinforcement repair technique. A meaningful KOOS sport and recreation change and signiicant improvements in the KOOS, VAS-pain and VR-12 physical scores as well as a signiicant decrease of the Marx activity scale in comparison to preoperative scores are demonstrated. Two of the 42 patients (4.8%) reported an ACL rerupture. Repair with this technique could be clinically relevant as a treatment option for patients with an acute, proximal ACL rupture which is not retracted and of good tissue quality. Level of evidence IV.

Purpose. To assess anterolateral complex (ALC) injuries in patients with acute anterior cruciate ligament (ACL) rupture on magnetic resonance imaging (MRI). Methods.Patients with acute ACL rupture who underwent ACL surgery between 2015 and 2017 and had an MRI within 6 weeks of the initial trauma were included. Two radiologists assessed MR images retrospectively for the status of the ALC, including the iliotibial band (ITB), Kaplan fibers, and anterolateral ligament (ALL), as follows: Grade 0: normal, Grade 1: periligamentous edema, Grade 2: partial, and Grade 3: complete tear. The findings were analysed using a Friedman test and weighted-kappa (κ) values .Results. Sixty-nine MRI scans were reviewed. Fifty-one % of 69 patients had associated injury of the ITB (Grade 1, n=31; Grade 2, n=4), 33% had associated injury of the Kaplan fibers (Grade 1, n=21; Grade 2, n=2), and 57% had associated injury of the ALL (Grade 1, n=12; Grade 2, n=22; Grade 3, n=5). There was a significant difference in the frequency and grading between ITB, Kaplan fiber and ALL injuries (P ≤ .032). Inter-reader agreement for assessing the ALC on MRI was almost perfect ( κ ≥ 0.922). Conclusion.Based on MRI analysis, ALL injuries were found with varying degrees of severity and intensity with noted injuries to associated surrounding fibers in patients with acute ACL rupture.

Until the past decade the common thought was that the anterior cruciate ligament (ACL) was not able to heal and restore knee stability. In this manuscript a brief review of studies of the developers and the early adaptors of four different modern ACL repair techniques are presented. The present status and considerations for the future of ACL repair and its research are shared. After promising short- to midterm ACL healing results by the developers, the results of the early adaptors show more variety in terms of rerupture and reintervention for other reasons. Risk factors for failure are a young age, high preinjury sports activity level, midsubstance ruptures and impaired integrity of the ACL bundles and the synovial sheath. There is a call for more clinical data and randomized clinical trials. Conclusion: an important finding of the past decade is that the ACL is able to heal and subsequently restabilize the knee. Patient selection is emphasized: the ideal patient is a non-high athlete older than 25 and has an acute proximal one bundle ACL rupture. Further research will have to show if ACL repair could be a game changer or if history will repeat itself.

Recently there has been renewed interest in primary repair of the anterior cruciate ligament (ACL). Repair of the acute proximal ruptured ACL can be achieved with the independent suture tape reinforcement ACL repair technique. The independent suture tape reinforcement technique reinforces the ligament as a secondary stabilizer, encouraging natural healing of the ligament by protecting it during the healing phase and supporting early mobilization. The purpose of this article is to describe, with video illustration, this ACL repair technique.