Anatomic Double-Bundle Reinsertion After Acute Proximal Anterior Cruciate Ligament Injury Using Knotless PushLock Anchors

Abstract

Direct anterior cruciate ligament (ACL) repair has been described with different suture techniques after acute ACL injury, but these procedures showed high failure rates. Recent studies, however, led to a better understanding of the biology of primary ACL healing. This article describes a novel technique combining the “healing response technique” with primary anatomic double-bundle ACL reinsertion after an acute proximal ACL tear using nonabsorbable No. 2 FiberWire (Arthrex, Naples, FL) and PushLock knotless suture anchors (Arthrex). We recommend this technique for patients with acute proximal avulsion–type ACL injuries. Postoperatively, we recommend a knee brace locked in full extension for at least 4 weeks to ensure adequate immobilization and then to increase knee flexion slowly over the next 4 weeks for subsequent healing of the ACL repair. Our technique combines anatomic positioning and reinsertion of the ACL bundles with microfracturing of the region delivering stem cells and growth factors to the repaired ACL, creating optimal conditions for the healing period. In certain cases this technique might be an alternative to conventional ACL reconstruction with autograft or allograft tendons.

Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction

“…In contrast to our study, in which we performed single-bundle refixation, the studies of both Weninger et al 19 and DiFelice et al 17 used a double-bundle refixation technique. We decided to perform a singlebundle ACL refixation technique to reduce the amount of suture material pulled through the ACL, which has the potential to cut the ACL bundle apart, and to minimize the risk of strangulation of the ACL bundle.…”

“…Weninger et al 19 described a 2.9-mm PushLock anchor refixation technique for double-bundle reinsertion in acute femoral ACL avulsion tears, subsynovial ACL tears, and partial ACL tears. Clinical results were not provided.…”

Authors' Reply

“…Reviewing current studies on ACL repair, there is a clear trend towards favorable results in patients with evidence for proximal ACL tears and good tissue quality. 1,3,7 With careful patient selection and awareness of current ACL repair techniques by learning from the past, it might be possible to change the paradigm in ACL surgery.…”

The Results of Single Bundle Versus Double Bundle ACL Reconstruction Surgery, a Retrospective Study and Review of Literature

“…An estimated 100,000 ACL reconstructions are performed yearly in US (1). ACL reconstruction had been recommended for active patients to avoid instability and subsequent meniscus and cartilage tears (1).…”

“…An estimated 100,000 ACL reconstructions are performed yearly in US (1). ACL reconstruction had been recommended for active patients to avoid instability and subsequent meniscus and cartilage tears (1). Investigators in recent studies reported that 63%-75% of patients returned to pre-injury sports activity and only 44% of patients were able to perform competitive sports activity (2).…”