The healing potential of an acutely repaired ACL: a sequential MRI study

Abstract

Background: Recently, there has been renewed interest in primary anterior cruciate ligament (ACL) repair. The aim of this study is to report early clinical and radiological results of a consecutive series of acute ACL tears treated with arthroscopic primary ACL repair within 14 days from injury. Patients and methods: A consecutive series of patients with acute ACL tears were prospectively included in the study. Based on MRI appearance, ACL tears were classified into five types, and tissue quality was graded as good, fair, and poor. Patients with type I, II, and III tears and at least 50% of ACL tibial remnant intact with good tissue quality were ultimately included. Clinical outcomes were measured using the Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), subjective and objective International Knee Documentation Committee (IKDC) scores, and KT-1000. Patients were also followed up with MRI evaluations at 1, 3, and 6 months postoperatively. ACL appearance was graded based on morphology (normal or abnormal) and signal intensity (isointense, intermediate, and hyperintense). Results: The mean TLKSS was 98.1, the mean subjective IKDC was 97.6, and the mean KOOS was 98.2. The objective IKDC score was A in eight of ten patients and B in two patients. KT-1000 measurements showed a maximum manual side-to-side difference of less than 2 mm in eight of ten patients, whereas two patients showed a difference of 3 mm. The morphology of the repaired ACL was normal (grade 1) at 1 month follow-up in ten of ten cases, and this appearance persisted at 3 and 6 months postoperatively. The signal intensity at 1 month postoperatively was graded as isointense (grade 1) in four of ten patients, intermediate (grade 2) in five of ten patients, and hyperintense (grade 3) in one of ten patients. At both 3 and 6 months postoperatively, the signal intensity was graded as isointense (grade 1) in nine of ten patients and intermediate (grade 2) in one of ten patients. Conclusions: Arthroscopic primary ACL repair performed acutely in a carefully selected group of patients with proximal ACL tears and good tissue quality showed good early clinical and radiological results.

Combined ACL and Segond Repair in Combined Acute Proximal ACL Tears and Segond Fracture

“…Ferretti et al. 5 demonstrated that appearance of an acutely repaired ACL seems normal or close to normal in all but one case (90%) by 3 months and normal in all cases by 6 months.…”

“… 1 , 2 , 3 With the benefit of modern arthroscopic surgical techniques and devices, there has been a renewed curiosity in primary repair of ACL. 4 , 5 This procedure may be a surgical alternative for those patients presenting with functional impairment after acute proximal ACL injuries with potentially less morbidity, although clinical outcomes for ACL repair using modern techniques is still limited. The ACL is the most important restraint to anterior tibial translation, and recent surgical and biomechanical studies have shown that anterolateral rotational instability (ALRI) is the effect of only a combined lesion of the ACL and secondary restraints, such as anterolateral ligament (ALL) and capsule, Segond fracture, and lateral meniscus posterior root (LMPRT).…”

Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation

“…Ferretti et al. 11 showed good short-term clinical outcomes after ACL repair in acute injuries and also excellent MRI findings with early recovery of a normal morphology and signal intensity.…”

“…With the advent of new surgical techniques, materials, and devices, there has been a renewed interest in primary repair of ACL, with some recent studies on ACL repair showing good-to-excellent results and failure rate ranging from 7% to 15% of cases. 9 , 10 , 11 …”

“… 6 , 7 , 8 Moreover, recently with the advent of new surgical techniques, materials, and devices, there has been renewed interest in primary repair of acute ACL tears in proximal tears with good tissue quality of the tibial remnant. 9 , 10 , 11 This technique demonstrates the use of arthroscopic primary ACL repair concurrently with percutaneous minimally invasive reinforcement of the ALL using suture augmentation.…”