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. 2025 May 29;14(8):103660.
doi: 10.1016/j.eats.2025.103660. eCollection 2025 Aug.

The Anatomic Biologic Anterior Cruciate Ligament Primary Repair Technique

Sebastian Conner-Rilk  1   2   3 , Valentin Hingsamer  1   4 , Fidelius von Rehlingen-Prinz  1   5 , Maximilian M Mueller  1   6 , Tatiana Monteleone  1 , Vincent J DeLorenzi  1 , Robert J O'Brien  1   7 , Gregory S DiFelice  1
Affiliations

The Anatomic Biologic Anterior Cruciate Ligament Primary Repair Technique

Sebastian Conner-Rilk et al. Arthrosc Tech. .

Abstract

In this Technical Note, we present the anatomic biologic anterior cruciate ligament primary repair technique, a fully biological repair of proximally torn anterior cruciate ligaments. This approach promotes a biological healing environment through biointegrative materials that balance mechanical strength and biodegradability, minimizing synthetic burden and inflammatory responses.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: G.S.D. receives royalties, owns stock and is a paid consultant for Zimmer Biomet, and receives royalties from Arthrex; he provides consulting services and participates in funded research with Miach Orthopaedics. All other authors (S.C-R., V.H., F.v.R-P., M.M.M., T.M., V. J.D., R.J.O.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
(A) Right knee preoperative magnetic resonance imaging view of the right knee displaying a proximal type 1 tear of the anterior cruciate ligament (ACL) in a 24-year-old woman. (B, C) Arthroscopic views from the anterolateral portal of the right knee, showing the tear gap (double-headed arrow) of the proximally torn type 1 ACL tear with excellent tissue quality using an arthroscopic probe in the same patient. (LFC, lateral femoral condyle.)
Fig 2
Fig 2
Arthroscopic view from the anterolateral portal of the right knee. (A, B) Placement of the anteromedial (AM) bundle repair sutures using a No. 2 ActivBraid Collagen Co-Braid Suture (triangle) and suture passer (star) from distally to proximally in an Bunnell-type pattern. (C, D) Placement of the posterolateral (PL) bundle repair sutures (arrow) using the same technique.
Fig 3
Fig 3
Arthroscopic view from the anterolateral portal of the right knee. Femoral suture anchor placement: (A, B) Tapping of holes for the posterolateral (PL) bundle's suture anchor into the femoral footprint. (C) Deployment of the PL suture anchor (square). (D, E). Tapping of a hole for the anteromedial (AM) bundle's suture anchor into the femoral footprint. (F) Deployment of the AM suture anchor (square), loaded with the suture augment (asterisk).
Fig 4
Fig 4
Arthroscopic view from the anterolateral portal of the right knee. (A) Performance of an additional posterolateral (PL) compression stitch using a suture passer (star) and the core stitch of the PL suture anchor from lateral to medial (asterisk). (B) Compression of the ligament with 3 alternating half hitches using a knot pusher (square) from medial to lateral to restore the native anatomic ligament vector.
Fig 5
Fig 5
Arthroscopic view from the anterolateral portal of the right knee. (A) Drilling of the tibial tunnel into the anterior one-third of the ACL’s tibial insertion for suture augmentation fixation using a 2.4-mm cannulated pin (arrow). (B) Completed anatomic biologic ACLPR, with the suture augmentation (asterisk) directed through the anterior one-third of the tibial ACL footprint.
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References

    1. Petersen W., Haner M., Guenther D., et al. Management after acute injury of the anterior cruciate ligament (ACL), part 2: Management of the ACL-injured patient. Knee Surg Sports Traumatol Arthrosc. 2023;31:1675–1689. - PubMed
    1. Rilk S., Saithna A., Achtnich A., et al. The modern-day ACL surgeon's armamentarium should include multiple surgical approaches including primary repair, augmentation, and reconstruction: A letter to the Editor. J ISAKOS. 2023;8:279–281. - PubMed
    1. van der List J.P., DiFelice G.S. Preservation of the anterior cruciate ligament: A treatment algorithm based on tear location and tissue quality. Am J Orthop (Belle Mead NJ) 2016;45:E393–E405. - PubMed
    1. Li J., Rothrauff B., Chen S., et al. Trends in anterior cruciate ligament repair: A bibliometric and visualized analysis. Orthop J Sports Med. 2022;10 - PMC - PubMed
    1. Heusdens C.H.W., Hopper G.P., Dossche L., Mackay G.M. Anterior cruciate ligament repair using independent suture tape reinforcement. Arthrosc Tech. 2018;7:e747–e753. - PMC - PubMed

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