Primary Repair of the Anterior Cruciate Ligament: A Review of the Literature

Anterior Cruciate Ligament (ACL) repair was first performed over a century ago, but reconstruction has overwhelmingly been the surgery of choice for operative ACL ruptures since the 1970s. However, high rates of osteoarthritis and low return to play rates following conventional ACL reconstruction have prompted clinicians to re-examine the utility of ACL repair with emphasis on biologic therapy, operative techniques and patient selection. The purpose of this review is to provide an indepth summary of the most recent advances pertaining to primary ACL repair. A thorough literature search on studies published up to May of 2016 using Pubmed, Ovid Medline and Cochrane Review databases was performed. Full text articles were reviewed and information pertaining to our institution’s experience was included. There are promising results with good short-term outcomes for primary repair with or without biologic augmentation and newer operative techniques performed on carefully selected patients. However, long-term follow-up is lacking, and therefore these studies cannot conclusively impact clinical practice. Long-term follow-up and further studies are needed to further elucidate the role of primary ACL repair.