ACL Repair

Written By Mandy Gilchrist

Who may be suitable for ACL repair?

Advances in surgical techniques have led to ACL repair becoming an option for proximal ACL tears. It is primarily considered in carefully selected patients with a proximal ACL avulsion, where the remaining ligament tissue is of sufficient quality to be repaired.

It may be particularly useful for:

  • Patients with a proximal ACL avulsion and persistent clinical instability

  • Higher-risk individuals who are likely to experience further pivoting or giving-way episodes despite partial healing

  • Patients requiring meniscal repair or stabilisation of another ligament, where a partially healed ACL remains functionally loose

Potential benefits of ACL repair

Arthroscopic ACL repair is a relatively low-morbidity procedure that preserves the patient’s native ligament.

Potential advantages include:

  • Less surgical disruption than ACL reconstruction

  • Faster early rehabilitation

  • Earlier progression towards running and return-to-sport testing

  • Avoiding graft harvest and therefore harvest site morbidity

Preventing recurrent instability is important because repeated pivoting episodes may cause permanent injury to the meniscus or joint cartilage.

ACL reconstruction remains available in the future should the repair fail or a further injury occur. Repair does not usually compromise future reconstruction options.

Rehabilitation after isolated ACL repair

Rehabilitation may progress relatively quickly when no meniscal repair or additional ligament procedure is required.

A typical pathway may include:

  • Day surgery

  • Crutches for comfort during the first few days

  • Physiotherapy commencing after approximately one week

  • Stationary cycling from around two weeks, provided knee movement allows

  • Running from approximately two months

  • Return-to-sport testing from around five months

These timeframes are guides only. Progression depends on knee movement, strength, stability and achievement of rehabilitation milestones.

Take-home message

  • ACL repair can be an excellent option for appropriately selected patients.

  • Clinical assessment of ACL laxity and individual risk factors is essential when determining suitability.

  • The main goal is to restore stability and prevent further giving-way episodes.

Mandy Gilchrist
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Proximal ACL Avulsion Injuries