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Comparative Study
. 2025 Jul;41(7):2648-2665.
doi: 10.1016/j.arthro.2024.09.008. Epub 2024 Sep 12.

Anterior Cruciate Ligament Repair Results in Similar Patient-Reported Outcome Measures as Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospective Comparative Studies

Rodrigo Saad Berreta  1 , Juan Bernardo Villarreal-Espinosa  1 , Lucas Pallone  1 , Eric Cotter  1 , Jonathan Spaan  2 , Ashwinee Manivannan  2 , Garrett R Jackson  1 , Jose Rafael Garcia  1 , Salvador Ayala  1 , Nikhil N Verma  1 , Brian J Cole  1 , Jorge Chahla  3
Affiliations
Comparative Study

Anterior Cruciate Ligament Repair Results in Similar Patient-Reported Outcome Measures as Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospective Comparative Studies

Rodrigo Saad Berreta et al. Arthroscopy. 2025 Jul.

Abstract

Purpose: To investigate the patient-reported outcomes (PROs), knee stability, and complications in prospective comparative studies of patients undergoing augmented anterior cruciate ligament (ACL) repair compared with anterior cruciate ligament reconstruction (ACLR).

Methods: A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Human clinical studies of Level I-II evidence comparing PROs, knee stability, and complications after ACL repair and reconstruction were included, and a qualitative analysis was performed. Excluded studies included those lacking reporting outcomes, studies that performed open ACLR or repair, studies published before the year 2000, and studies with evidence Levels III-IV. Study quality was assessed using the Cochrane Collaboration's risk of bias tool.

Results: Seven Level I-II studies were retained, comprising 190 ACLR and 221 repairs (75 bridge-enhanced ACL repair [BEAR], 49 suture augmentation [SA], and 97 dynamic intraligamentary stabilization [DIS]). At final follow-up, re-rupture rates varied between 0 and 14% (BEAR) versus 0 and 6% (ACLR) and mean side-to-side differences measured using KT-1000 testing ranged from 1.6 to 1.9 mm (BEAR) versus 1.7 to 3.14 mm (ACLR). For DIS versus ACLR, mean anterior tibial translation values at final follow-up were 1.7 mm (DIS) versus 1.4 mm (ACLR), and re-rupture rates ranged from 20.8% to 29% (DIS) versus 17% to 27.2% (ACLR). For SA versus ACLR, the mean side-to-side difference ranged from 0.2 to 0.39 mm (SA) versus 0.33 to 0.4 mm (ALCR), whereas the re-rupture rates were 10% (SA) versus 0% (ACLR). International Knee Documentation Committee, Tegner, Lysholm, and Knee Injury and Osteoarthritis Outcome scores across both cohorts exhibited statistically significant, and comparable improvement, from baseline to final follow-up ranging from 1 to 5 years.

Conclusions: Augmented ACL repair results in similar patient-reported outcome measures in comparison with ACLR. However, augmented ACL repair may be associated with greater rates of failure, given re-rupture rates of up to 14%, 29%, and 10% for BEAR, DIS, and SA, respectively.

Level of evidence: Level II, systematic review of Level I-II studies.

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Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: J.C. reports board membership for American Orthopaedic Society for Sports Medicine, with Arthroscopy Association of North America, and International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine; consulting or advisory for Arthrex, CONMED Corp, and Ossur Americas; and consulting or advisory and speaking and lecture fees form Smith & Nephew. B.J.C. reports funding grants from B Braun Medical, board membership for American Journal of Sports Medicine, Arthroscopy Association of North America, and Journal of American Academy of Orthopaedic Surgeons; consulting or advisory and funding grants from Arthrex; equity or stocks from Bandgrip and OSSIO; consulting or advisory with Elsevier and Operative Techniques in Sports Medicine; and funding grafts from JRF Ortho and National Institutes of Health. N.N.V. reports board membership with American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, Slack Incorporated; funding grants from Arthrex, Breg, and Ossur Americas; and consulting or advisory and funding grants from Stryker; and IP royalties and funding grants from Smith & Nephew. All other authors (R.S.B., J.B.V-E., L.P., E.C., J.S., A.M., G.J., J.R.G., S.A.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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