Editorial Commentary: Preservation of the Ruptured Anterior Cruciate Ligament-Evidence of Ligamentous Maturation After Primary Repair

Abstract

The long-standing belief that the anterior cruciate ligament (ACL) cannot be successfully repaired to achieve subsequent healing is increasingly being challenged by emerging clinical and imaging evidence. Recent studies have demonstrated favorable short- to midterm outcomes after selective, arthroscopic ACL primary repair, particularly in the setting of proximal tears with good or excellent tissue quality. Magnetic resonance imaging follow-up indicates progressive ligamentous maturation and remodeling during the first 2 years postoperatively, supporting the notion of sufficient biological healing potential with preservation of tissue integrity in selected cases. Clinically, patients undergoing primary repair have demonstrated excellent patient-reported outcomes, as well as preservation of anterior knee stability with comparable results achieved after ACL reconstruction in certain populations. Moreover, primary repair offers several reported potential advantages because it preserves the native ACL, avoids autograft harvesting and tunnel drilling, and maintains proprioceptive function, all while reestablishing biomechanical stability. By bridging the gap between nonoperative treatment and reconstruction techniques, ACL primary repair should be part of an individualized, injury-specific, patient-centered treatment strategy.