There has been a renewed interest in ACL primary repairs as the treatment for Sherman type I and type II ACL ruptures. Careful analysis of historical data has revealed that certain ACL tear subgroups, especially proximal tears with good tissue quality, have positive clinical outcomes with primary ACL repair.¹

Studies reporting outcomes of remnant-preserving ACL surgeries have shown encouraging results with a higher potential for early healing and better functional outcomes compared with remnant-resecting surgeries.² Preservation of the native ACL using the primary repair technique can achieve short-term clinical success and result in good clinical outcomes at 3-year follow-up in this carefully selected patient population.³

Arthroscopic primary repair is a conservative approach in that no grafts need to be harvested, no tunnels need to be drilled, and revision surgery, if necessary, is more analogous to primary reconstructions.⁴ The goal of the procedure is to preserve the remnant native ligament. By doing this, the native nerve endings and blood supply are preserved.⁵

^References

^{1. van der List JP, DiFelice GS. Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: a systematic review of historical studies. Knee. 2017;24(5):898-908. doi:10.1016/j.knee.2017.05.009}

^{2. van der List JP, DiFelice GS. Successful arthroscopic primary repair of a chronic anterior cruciate ligament tear 11 years following injury. HSS J. 2017;13(1):90-95. doi:10.1007/s11420-016-9530-8}

^{3. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):21-28. doi:10.1007/s00167-018-5338-z}

^{4. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 2015;31(11):2162-2171. doi:10.1016/j.arthro.2015.08.010}

^{5. DiFelice GS, van der List JP. Arthroscopic primary repair of proximal anterior cruciate ligament tears. Arthrosc Tech. 2016;5(5):e1057-e1061. doi:10.1016/j.eats.2016.05.009}

^{The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.}

Educational Resources (16)

Revision Date: 01/19/2022

Surgical Technique Videos \| Presenter: Patrick A. Smith, MD Anterior Cruciate Ligament Primary Repair With ACL Repair TightRope^® Implant and FiberRing™ Sutures	Testimonials \| Presenter: Gregory S. DiFelice, MD ACL Primary Repair Using the InternalBrace™ Technique Gets Runner Back on the Trail	Surgical Technique Animations ACL Repair TightRope^® Surgical Technique Animation
Surgical Technique Guides ACL Preservation With the ACL Repair TightRope^® Implant	Surgical Technique Videos \| Presenter: Gordon Mackay, MD ACL Primary Repair Using the InternalBrace™ Technique	Presentation Videos \| Presenter: Wiemi A. Douoguih, MD ACL Repair with InternalBrace™ Ligament Augmentation
Testimonials \| Presenter: Gregory S. DiFelice, MD ACL Preservation: A Unique Case Report of ACL Primary Repair With InternalBrace™ Ligament Augmentation	Surgical Technique Videos \| Presenter: Patrick A. Smith, MD ACL Primary Repair With InternalBrace™ Ligament Augmentation and AlloSync™ Demineralized Bone Matrix Augmentation	Video Series \| Presenters: Christopher Adams, MD, Gregory S. DiFelice, MD, Bertrand Sonnery-Cottet, MD, Wiemi A. Douoguih, MD BreakThrough™ with Christopher Adams, MD - Episode 10: ACL Primary Repair
Outcomes Reports ACL Repair with InternalBrace™ Ligament Augmentation	Scientific Updates ACL Primary Repair Scientific Update: A Review of Modern Techniques	Surgical Technique Animations ACL Preservation With the SwiveLock^® ACL Repair Kit
Surgical Technique Guides SwiveLock^® ACL Primary Repair Implant System	Surgical Technique Videos \| Presenter: Rachel M. Frank, MD Tibial Spine Avulsion Fracture Reduction Using ACL Repair TightRope^® Implant and FiberRing™ Suture	Product and Technique Highlights ACL Repair TightRope^® Implant
Surgical Technique Videos \| Presenter: Gregory S. DiFelice, MD Posterior Cruciate Ligament Primary Repair With PCL Repair TightRope^® Implant and FiberRing™ Sutures