Primary Arthroscopic Repair of the Anterior Cruciate Ligament: A Systematic Review of Clinical Outcomes

Abstract

Purpose: To describe the clinical outcomes after primary arthroscopic anterior cruciate ligament (ACL) repair.

Methods: A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the PRISMA guidelines. All English-language literature published from 2000 to 2018 that reported the clinical outcomes after primary arthroscopic repair (AR) of complete tear of the ACL (without augmentation) with a minimum 2-year follow-up was reviewed by 2 independent reviewers. Outcomes included repair failure, reoperation, postoperative knee stability, and patient-reported outcomes. Descriptive statistics are presented. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Nonrandomized Studies (MINORS) score.

Results: Six studies (2 level III, 4 level IV) were included. The mean MCMS was 62.2. The mean MINORS score for noncomparative studies was 11.8, and for comparative studies, 18. Six studies reported outcomes of 89 patients who underwent AR of the ACL from 2007 to 2016 (age, 8 to 67 years; follow-up, 24 to 110 months). All 6 studies included exclusively proximal avulsion tears. Overall, 0% to 25.0% of patients experienced repair failure (I² = 23.7%; 95% confidence interval, 0% to 67.6%), and 0% to 20.0% of patients had a subsequent reoperation (I² = 12.1%; 95% confidence interval, 0% to 77.7%). Similar inconsistent results were shown for postoperative knee stability measures and patient-reported outcomes.

Conclusions: The literature on clinical outcomes of primary arthroscopic ACL repair is limited. The reported rates of repair failure and reoperation are highly inconsistent. Most studies report relatively high failure rates.

Level of evidence: IV, systematic review of level III and IV studies.