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Letter to the Editor| Volume 8, ISSUE 4, P279-281, August 2023

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The modern-day ACL surgeon's armamentarium should include multiple surgical approaches including primary repair, augmentation, and reconstruction: A letter to the Editor

Open AccessPublished:April 04, 2023DOI:https://doi.org/10.1016/j.jisako.2023.03.434
The modern-day ACL surgeon's armamentarium should include multiple surgical approaches including primary repair, augmentation, and reconstruction: A letter to the Editor
Previous Article“Cannula-in-cannula” technique for turbulence control and suture management in arthroscopic superior capsular reconstruction—A technical note

Keywords

We would like to thank the authors for their highly valuable publication [
  • Tuca M.
  • Valderrama I.
  • Eriksson K.
  • Tapasvi S.
Current trends in ACL surgery. A worldwide benchmark study.
J ISAKOS. 2022; https://doi.org/10.1016/j.jisako.2022.08.009
] and commend them for conducting the largest ACL survey performed to date, including over 2000 ISAKOS sport surgeons. The study illuminates current trends in ACL reconstruction (ACLR) surgery and highlights the variation in techniques used depending on a surgeon's location and expertise [
  • Tuca M.
  • Valderrama I.
  • Eriksson K.
  • Tapasvi S.
Current trends in ACL surgery. A worldwide benchmark study.
J ISAKOS. 2022; https://doi.org/10.1016/j.jisako.2022.08.009
].
Hereby, we would like to provide our critique on both the chosen title and methods used. We strongly believe that the “benchmark” in today's ACL surgery is not solely represented by ACLR, but rather by a patient-individualized decision process that considers the complete, modern-day ACL surgery toolkit (e.g. primary repair, augmentation, and reconstruction).
The authors of this letter are aware of the ongoing reluctance toward ACL primary repair (ACLPR) within today's orthopedic sports medicine and trauma community. ACLPR had been abandoned after historical open ACL repair techniques were reported to have high failure and complication rates at mid-term follow-up [
  • Engebretsen L.
  • Benum P.
  • Fasting O.
  • Molster A.
  • Strand T.
A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament.
Am J Sports Med. 1990; 18: 585-590https://doi.org/10.1177/036354659001800605
,
  • Feagin Jr., J.A.
  • Curl W.W.
Isolated tear of the anterior cruciate ligament: 5-year follow-up study.
Am J Sports Med. 1976; 4: 95-100https://doi.org/10.1177/036354657600400301
,
  • Odensten M.
  • Lysholm J.
  • Gillquist J.
Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up.
Acta Orthop Scand. 1984; 55: 270-272https://doi.org/10.3109/17453678408992354
]. Over the past decade, there has been a resurgence of interest in modern-day ACL primary repair as new arthroscopic techniques, rehabilitation protocols [
  • Hoogeslag R.A.G.
  • Brouwer R.W.
  • de Vries A.J.
  • Boer B.C.
  • Huis In ’t Veld R.
Efficacy of nonaugmented, static augmented, and dynamic augmented suture repair of the ruptured anterior cruciate ligament: a systematic review of the literature.
Am J Sports Med. 2020; 48: 3626-3637https://doi.org/10.1177/0363546520904690
,
  • Li J.
  • Rothrauff B.
  • Chen S.
  • Zhao S.
  • Wu Z.
  • Chen Q.
  • et al.
Trends in anterior cruciate ligament repair: a bibliometric and visualized analysis.
Orthopaedic Journal of Sports Medicine. 2022; https://doi.org/10.1177/23259671221132564
], and an appropriate patient selection algorithm based on tear type and tissue quality have been adopted [
  • Hopper G.P.
  • Aithie J.M.S.
  • Jenkins J.M.
  • Wilson W.T.
  • Mackay G.M.
Combined anterior cruciate ligament repair and anterolateral ligament internal brace augmentation: minimum 2-year patient-reported outcome measures.
Orthop J Sports Med. 2020; 82325967120968557https://doi.org/10.1177/2325967120968557
,
  • 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 (PMID: 28005092): E393-E405
]. With this in mind, historic outcomes using obsolete techniques and rehabilitation protocols [
  • Engebretsen L.
  • Benum P.
  • Fasting O.
  • Molster A.
  • Strand T.
A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament.
Am J Sports Med. 1990; 18: 585-590https://doi.org/10.1177/036354659001800605
,
  • Feagin Jr., J.A.
  • Curl W.W.
Isolated tear of the anterior cruciate ligament: 5-year follow-up study.
Am J Sports Med. 1976; 4: 95-100https://doi.org/10.1177/036354657600400301
,
  • Odensten M.
  • Lysholm J.
  • Gillquist J.
Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up.
Acta Orthop Scand. 1984; 55: 270-272https://doi.org/10.3109/17453678408992354
] should not be confused with results using state-of-the-art techniques on an evidence-based selected patient cohort, as these techniques show acceptable and comparable failure rates at early and mid-term follow-up as compared to ACLR [
  • Ferreira A.
  • Saithna A.
  • Carrozzo A.
  • Guy S.
  • Vieira T.D.
  • Barth J.
  • et al.
The minimal clinically important difference, patient acceptable symptom state, and clinical outcomes of anterior cruciate ligament repair versus reconstruction: a matched-pair analysis from the SANTI study group.
Am J Sports Med. 2022; https://doi.org/10.1177/03635465221126171
,
  • Heusdens C.H.W.
  • Hopper G.P.
  • Dossche L.
  • Roelant E.
  • Mackay G.M.
Anterior cruciate ligament repair with Independent Suture Tape Reinforcement: a case series with 2-year follow-up.
Knee Surg Sports Traumatol Arthrosc. 2019; 27: 60-67https://doi.org/10.1007/s00167-018-5239-1
,
  • Hopper G.P.
  • Aithie J.M.S.
  • Jenkins J.M.
  • Wilson W.T.
  • Mackay G.M.
Combined anterior cruciate ligament repair and anterolateral ligament internal brace augmentation: minimum 2-year patient-reported outcome measures.
Orthop J Sports Med. 2020; 82325967120968557https://doi.org/10.1177/2325967120968557
,
  • Hoogeslag R.A.G.
  • Huis In ’t Veld R.
  • Brouwer R.W.
  • de Graaff F.
  • Verdonschot N.
Acute anterior cruciate ligament rupture: repair or reconstruction? Five-year results of a randomized controlled clinical trial.
Am J Sports Med. 2022; 50: 1779-1787https://doi.org/10.1177/03635465221090527
,
  • Jonkergouw A.
  • van der List J.P.
  • DiFelice G.S.
Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg.
Sports Traumatol Arthrosc. 2019; 27: 21-28https://doi.org/10.1007/s00167-018-5338-z
,
  • Vermeijden H.D.
  • Monaco E.
  • Marzilli F.
  • Yang X.A.
  • van der List J.P.
  • Ferretti A.
  • et al.
Primary repair versus reconstruction in patients with bilateral anterior cruciate ligament injuries: what do patients prefer?.
Adv Orthop. 2022; 2022: 3558311https://doi.org/10.1155/2022/3558311
,
  • Vermeijden H.D.
  • van der List J.P.
  • Benner J.L.
  • Rademakers M.V.
  • Kerkhoffs G.
  • DiFelice G.S.
Primary repair with suture augmentation for proximal anterior cruciate ligament tears: a systematic review with meta-analysis.
Knee. 2022; 38: 19-29https://doi.org/10.1016/j.knee.2022.07.001
,
  • Vermeijden H.D.
  • van der List J.P.
  • DiFelice G.S.
Acute and delayed anterior cruciate ligament repair results in similar short to mid-term outcomes.
Knee. 2021; 29: 142-149https://doi.org/10.1016/j.knee.2021.01.028
,
  • Vermeijden H.D.
  • Yang X.A.
  • van der List J.P.
  • DiFelice G.S.
Role of age on success of arthroscopic primary repair of proximal anterior cruciate ligament tears.
Arthroscopy. 2021; 37: 1194-1201https://doi.org/10.1016/j.arthro.2020.11.024
,
  • Wilson W.T.
  • Hopper G.P.
  • Banger M.S.
  • Blyth M.J.G.
  • Riches P.E.
  • MacKay G.M.
Anterior cruciate ligament repair with internal brace augmentation: a systematic review.
Knee. 2022; 35: 192-200https://doi.org/10.1016/j.knee.2022.03.009
,
  • Schneider K.N.
  • Ahlbaumer G.
  • Gosheger G.
  • Theil C.
  • Weller J.
  • Goth A.
Promising functional outcomes following anterior cruciate ligament repair with suture augmentation.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov 29; (epub ahead of print)https://doi.org/10.1007/s00167-022-07236-4
].
Even if recent randomized-controlled trials reported good short- and mid-term results of ACL primary repair compared to ACLR, it has to be highlighted that until now, high-quality long-term evidence for ACL primary repair is still limited given its recent resurgence [
  • Glasbrenner J.
  • Raschke M.J.
  • Kittl C.
  • Herbst E.
  • Peez C.
  • Briese T.
  • et al.
Comparable instrumented knee joint laxity and patient-reported outcomes after ACL repair with dynamic intraligamentary stabilization or ACL reconstruction: 5-year results of a randomized controlled trial.
Am J Sports Med. 2022; 50: 3256-3264https://doi.org/10.1177/03635465221117777
,
  • Hoogeslag R.A.G.
  • Brouwer R.W.
  • de Vries A.J.
  • Boer B.C.
  • Huis In ’t Veld R.
Efficacy of nonaugmented, static augmented, and dynamic augmented suture repair of the ruptured anterior cruciate ligament: a systematic review of the literature.
Am J Sports Med. 2020; 48: 3626-3637https://doi.org/10.1177/0363546520904690
,
  • Hoogeslag R.A.G.
  • Huis In ’t Veld R.
  • Brouwer R.W.
  • de Graaff F.
  • Verdonschot N.
Acute anterior cruciate ligament rupture: repair or reconstruction? Five-year results of a randomized controlled clinical trial.
Am J Sports Med. 2022; 50: 1779-1787https://doi.org/10.1177/03635465221090527
,
  • Jonkergouw A.
  • van der List J.P.
  • DiFelice G.S.
Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg.
Sports Traumatol Arthrosc. 2019; 27: 21-28https://doi.org/10.1007/s00167-018-5338-z
,
  • Kosters C.
  • Glasbrenner J.
  • Spickermann L.
  • Kittl C.
  • Domnick C.
  • Herbort M.
  • et al.
Repair with dynamic intraligamentary stabilization versus primary reconstruction of acute anterior cruciate ligament tears: 2-year results from a prospective randomized study.
Am J Sports Med. 2020; 48: 1108-1116https://doi.org/10.1177/0363546520905863
]. However, non-negatable functional outcome parameters considering the success of a surgical procedure must be considered: rehabilitation following primary ACL primary repair has been shown to be faster and less painful [
  • Vermeijden H.D.
  • Monaco E.
  • Marzilli F.
  • Yang X.A.
  • van der List J.P.
  • Ferretti A.
  • et al.
Primary repair versus reconstruction in patients with bilateral anterior cruciate ligament injuries: what do patients prefer?.
Adv Orthop. 2022; 2022: 3558311https://doi.org/10.1155/2022/3558311
], given the repair's minimally invasive nature and no graft harvesting. Furthermore, it provides greater and earlier return of full range of motion (ROM) [
  • van der List J.P.
  • DiFelice G.S.
Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament.
Knee. 2017; 24: 798-807https://doi.org/10.1016/j.knee.2017.04.007
,
  • Vermeijden H.D.
  • Monaco E.
  • Marzilli F.
  • Yang X.A.
  • van der List J.P.
  • Ferretti A.
  • et al.
Primary repair versus reconstruction in patients with bilateral anterior cruciate ligament injuries: what do patients prefer?.
Adv Orthop. 2022; 2022: 3558311https://doi.org/10.1155/2022/3558311
], and at short and mid-term follow-up, excellent patient-reported outcomes (PROMs) have been reported [
  • Glasbrenner J.
  • Raschke M.J.
  • Kittl C.
  • Herbst E.
  • Peez C.
  • Briese T.
  • et al.
Comparable instrumented knee joint laxity and patient-reported outcomes after ACL repair with dynamic intraligamentary stabilization or ACL reconstruction: 5-year results of a randomized controlled trial.
Am J Sports Med. 2022; 50: 3256-3264https://doi.org/10.1177/03635465221117777
,
  • Hoogeslag R.A.G.
  • Huis In ’t Veld R.
  • Brouwer R.W.
  • de Graaff F.
  • Verdonschot N.
Acute anterior cruciate ligament rupture: repair or reconstruction? Five-year results of a randomized controlled clinical trial.
Am J Sports Med. 2022; 50: 1779-1787https://doi.org/10.1177/03635465221090527
,
  • Jonkergouw A.
  • van der List J.P.
  • DiFelice G.S.
Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg.
Sports Traumatol Arthrosc. 2019; 27: 21-28https://doi.org/10.1007/s00167-018-5338-z
,
  • Kosters C.
  • Glasbrenner J.
  • Spickermann L.
  • Kittl C.
  • Domnick C.
  • Herbort M.
  • et al.
Repair with dynamic intraligamentary stabilization versus primary reconstruction of acute anterior cruciate ligament tears: 2-year results from a prospective randomized study.
Am J Sports Med. 2020; 48: 1108-1116https://doi.org/10.1177/0363546520905863
,
  • Vermeijden H.D.
  • Monaco E.
  • Marzilli F.
  • Yang X.A.
  • van der List J.P.
  • Ferretti A.
  • et al.
Primary repair versus reconstruction in patients with bilateral anterior cruciate ligament injuries: what do patients prefer?.
Adv Orthop. 2022; 2022: 3558311https://doi.org/10.1155/2022/3558311
,
  • Vermeijden H.D.
  • van der List J.P.
  • Benner J.L.
  • Rademakers M.V.
  • Kerkhoffs G.
  • DiFelice G.S.
Primary repair with suture augmentation for proximal anterior cruciate ligament tears: a systematic review with meta-analysis.
Knee. 2022; 38: 19-29https://doi.org/10.1016/j.knee.2022.07.001
,
  • Vermeijden H.D.
  • Yang X.A.
  • van der List J.P.
  • DiFelice G.S.
Role of age on success of arthroscopic primary repair of proximal anterior cruciate ligament tears.
Arthroscopy. 2021; 37: 1194-1201https://doi.org/10.1016/j.arthro.2020.11.024
,
  • Wilson W.T.
  • Hopper G.P.
  • Banger M.S.
  • Blyth M.J.G.
  • Riches P.E.
  • MacKay G.M.
Anterior cruciate ligament repair with internal brace augmentation: a systematic review.
Knee. 2022; 35: 192-200https://doi.org/10.1016/j.knee.2022.03.009
,
  • Schneider K.N.
  • Ahlbaumer G.
  • Gosheger G.
  • Theil C.
  • Weller J.
  • Goth A.
Promising functional outcomes following anterior cruciate ligament repair with suture augmentation.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov 29; (epub ahead of print)https://doi.org/10.1007/s00167-022-07236-4
].
The authors presented several clinical scenarios with varied age and sports participation. We suggest that tear location and timing of injury are also critically important. With these factors considered, a preservation-first approach [
  • 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 (PMID: 28005092): E393-E405
] might be indicated. The survey, as presented, queried surgeons about graft choices as if ACLR would be the only valid treatment option. Again, we strongly believe that this is an antiquated approach.
Considering the positive functional outcomes [
  • Ferreira A.
  • Saithna A.
  • Carrozzo A.
  • Guy S.
  • Vieira T.D.
  • Barth J.
  • et al.
The minimal clinically important difference, patient acceptable symptom state, and clinical outcomes of anterior cruciate ligament repair versus reconstruction: a matched-pair analysis from the SANTI study group.
Am J Sports Med. 2022; https://doi.org/10.1177/03635465221126171
,
  • Glasbrenner J.
  • Raschke M.J.
  • Kittl C.
  • Herbst E.
  • Peez C.
  • Briese T.
  • et al.
Comparable instrumented knee joint laxity and patient-reported outcomes after ACL repair with dynamic intraligamentary stabilization or ACL reconstruction: 5-year results of a randomized controlled trial.
Am J Sports Med. 2022; 50: 3256-3264https://doi.org/10.1177/03635465221117777
,
  • Ferretti A.
  • Monaco E.
  • Annibaldi A.
  • Carrozzo A.
  • Bruschi M.
  • Argento G.
  • et al.
The healing potential of an acutely repaired ACL: a sequential MRI study.
J Orthop Traumatol. 2020; 21: 14https://doi.org/10.1186/s10195-020-00553-9
,
  • Hoogeslag R.A.G.
  • Huis In ’t Veld R.
  • Brouwer R.W.
  • de Graaff F.
  • Verdonschot N.
Acute anterior cruciate ligament rupture: repair or reconstruction? Five-year results of a randomized controlled clinical trial.
Am J Sports Med. 2022; 50: 1779-1787https://doi.org/10.1177/03635465221090527
,
  • Jonkergouw A.
  • van der List J.P.
  • DiFelice G.S.
Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg.
Sports Traumatol Arthrosc. 2019; 27: 21-28https://doi.org/10.1007/s00167-018-5338-z
,
  • Kosters C.
  • Glasbrenner J.
  • Spickermann L.
  • Kittl C.
  • Domnick C.
  • Herbort M.
  • et al.
Repair with dynamic intraligamentary stabilization versus primary reconstruction of acute anterior cruciate ligament tears: 2-year results from a prospective randomized study.
Am J Sports Med. 2020; 48: 1108-1116https://doi.org/10.1177/0363546520905863
,
  • van der List J.P.
  • DiFelice G.S.
Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament.
Knee. 2017; 24: 798-807https://doi.org/10.1016/j.knee.2017.04.007
,
  • Vermeijden H.D.
  • Monaco E.
  • Marzilli F.
  • Yang X.A.
  • van der List J.P.
  • Ferretti A.
  • et al.
Primary repair versus reconstruction in patients with bilateral anterior cruciate ligament injuries: what do patients prefer?.
Adv Orthop. 2022; 2022: 3558311https://doi.org/10.1155/2022/3558311
,
  • Vermeijden H.D.
  • van der List J.P.
  • Benner J.L.
  • Rademakers M.V.
  • Kerkhoffs G.
  • DiFelice G.S.
Primary repair with suture augmentation for proximal anterior cruciate ligament tears: a systematic review with meta-analysis.
Knee. 2022; 38: 19-29https://doi.org/10.1016/j.knee.2022.07.001
,
  • Vermeijden H.D.
  • van der List J.P.
  • DiFelice G.S.
Acute and delayed anterior cruciate ligament repair results in similar short to mid-term outcomes.
Knee. 2021; 29: 142-149https://doi.org/10.1016/j.knee.2021.01.028
,
  • Vermeijden H.D.
  • Yang X.A.
  • van der List J.P.
  • DiFelice G.S.
Role of age on success of arthroscopic primary repair of proximal anterior cruciate ligament tears.
Arthroscopy. 2021; 37: 1194-1201https://doi.org/10.1016/j.arthro.2020.11.024
,
  • Wilson W.T.
  • Hopper G.P.
  • Banger M.S.
  • Blyth M.J.G.
  • Riches P.E.
  • MacKay G.M.
Anterior cruciate ligament repair with internal brace augmentation: a systematic review.
Knee. 2022; 35: 192-200https://doi.org/10.1016/j.knee.2022.03.009
,
  • Schneider K.N.
  • Ahlbaumer G.
  • Gosheger G.
  • Theil C.
  • Weller J.
  • Goth A.
Promising functional outcomes following anterior cruciate ligament repair with suture augmentation.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov 29; (epub ahead of print)https://doi.org/10.1007/s00167-022-07236-4
] and failure rates [
  • Ferreira A.
  • Saithna A.
  • Carrozzo A.
  • Guy S.
  • Vieira T.D.
  • Barth J.
  • et al.
The minimal clinically important difference, patient acceptable symptom state, and clinical outcomes of anterior cruciate ligament repair versus reconstruction: a matched-pair analysis from the SANTI study group.
Am J Sports Med. 2022; https://doi.org/10.1177/03635465221126171
,
  • Glasbrenner J.
  • Raschke M.J.
  • Kittl C.
  • Herbst E.
  • Peez C.
  • Briese T.
  • et al.
Comparable instrumented knee joint laxity and patient-reported outcomes after ACL repair with dynamic intraligamentary stabilization or ACL reconstruction: 5-year results of a randomized controlled trial.
Am J Sports Med. 2022; 50: 3256-3264https://doi.org/10.1177/03635465221117777
,
  • Heusdens C.H.W.
  • Hopper G.P.
  • Dossche L.
  • Roelant E.
  • Mackay G.M.
Anterior cruciate ligament repair with Independent Suture Tape Reinforcement: a case series with 2-year follow-up.
Knee Surg Sports Traumatol Arthrosc. 2019; 27: 60-67https://doi.org/10.1007/s00167-018-5239-1
,
  • Hopper G.P.
  • Aithie J.M.S.
  • Jenkins J.M.
  • Wilson W.T.
  • Mackay G.M.
Combined anterior cruciate ligament repair and anterolateral ligament internal brace augmentation: minimum 2-year patient-reported outcome measures.
Orthop J Sports Med. 2020; 82325967120968557https://doi.org/10.1177/2325967120968557
,
  • Hoogeslag R.A.G.
  • Huis In ’t Veld R.
  • Brouwer R.W.
  • de Graaff F.
  • Verdonschot N.
Acute anterior cruciate ligament rupture: repair or reconstruction? Five-year results of a randomized controlled clinical trial.
Am J Sports Med. 2022; 50: 1779-1787https://doi.org/10.1177/03635465221090527
,
  • Jonkergouw A.
  • van der List J.P.
  • DiFelice G.S.
Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg.
Sports Traumatol Arthrosc. 2019; 27: 21-28https://doi.org/10.1007/s00167-018-5338-z
,
  • Kosters C.
  • Glasbrenner J.
  • Spickermann L.
  • Kittl C.
  • Domnick C.
  • Herbort M.
  • et al.
Repair with dynamic intraligamentary stabilization versus primary reconstruction of acute anterior cruciate ligament tears: 2-year results from a prospective randomized study.
Am J Sports Med. 2020; 48: 1108-1116https://doi.org/10.1177/0363546520905863
,
  • Vermeijden H.D.
  • Monaco E.
  • Marzilli F.
  • Yang X.A.
  • van der List J.P.
  • Ferretti A.
  • et al.
Primary repair versus reconstruction in patients with bilateral anterior cruciate ligament injuries: what do patients prefer?.
Adv Orthop. 2022; 2022: 3558311https://doi.org/10.1155/2022/3558311
,
  • Vermeijden H.D.
  • van der List J.P.
  • Benner J.L.
  • Rademakers M.V.
  • Kerkhoffs G.
  • DiFelice G.S.
Primary repair with suture augmentation for proximal anterior cruciate ligament tears: a systematic review with meta-analysis.
Knee. 2022; 38: 19-29https://doi.org/10.1016/j.knee.2022.07.001
,
  • Vermeijden H.D.
  • van der List J.P.
  • DiFelice G.S.
Acute and delayed anterior cruciate ligament repair results in similar short to mid-term outcomes.
Knee. 2021; 29: 142-149https://doi.org/10.1016/j.knee.2021.01.028
,
  • Vermeijden H.D.
  • Yang X.A.
  • van der List J.P.
  • DiFelice G.S.
Role of age on success of arthroscopic primary repair of proximal anterior cruciate ligament tears.
Arthroscopy. 2021; 37: 1194-1201https://doi.org/10.1016/j.arthro.2020.11.024
,
  • Wilson W.T.
  • Hopper G.P.
  • Banger M.S.
  • Blyth M.J.G.
  • Riches P.E.
  • MacKay G.M.
Anterior cruciate ligament repair with internal brace augmentation: a systematic review.
Knee. 2022; 35: 192-200https://doi.org/10.1016/j.knee.2022.03.009
,
  • Schneider K.N.
  • Ahlbaumer G.
  • Gosheger G.
  • Theil C.
  • Weller J.
  • Goth A.
Promising functional outcomes following anterior cruciate ligament repair with suture augmentation.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov 29; (epub ahead of print)https://doi.org/10.1007/s00167-022-07236-4
], it must be emphasized that selective arthroscopic ACL primary repair is a reasonable treatment approach for ACL tears in appropriately selected patients [
  • 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 (PMID: 28005092): E393-E405
]. Lastly, considering ACL re-rupture, few bridges are burned performing primary ACL primary repair; thus, revision surgery is less complicated than after failed reconstruction [
  • van der List J.P.
  • Vermeijden H.D.
  • O’Brien R.
  • Difelice G.S.
Anterior cruciate ligament reconstruction following failed primary repair: surgical technique and a report of three cases.
Minerva Ortop Traumatol. 2019; 70: 70-77https://doi.org/10.23736/S0394-3410.19.03924-9
].
We want to thank the authors again for their valuable contribution and want to emphasize that this letter should not be perceived as an argument regarding “ACL primary repair vs. reconstruction”. Based on the current literature and the authors' collective professional experience, we opine that the modern-day ACL surgeon's toolbox is not limited to ACLR alone, but equipped with a multifaceted armamentarium of procedures. We strongly recommend that future benchmark surveys include a more complete representation of the surgical (primary repair, augmentation, and reconstruction) and non-surgical options to treat the ACL-injured patient.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:
Gregory S. DiFelice reports a relationship with Arthrex Inc that includes royalties and consulting.
Adnan Saithna reports a relationship with Arthrex Inc that includes consulting or advisory; and is a ISAKOS Committee member.
Clemens Koesters reports a relationship with Mathys AG Bettlach that includes consulting or advisory.
Edoardo Monaco reports a relationship with Arthrex Inc and Amplitude that includes consulting.
Etienne Cavaignac reports a relationship with Arthrex Inc that includes consulting or advisory.
Rachel M. Frank reports a relationship with Arthrex Inc that includes consulting; and with Elsevier: Publishing royalties, financial or material support.
Betrand Sonnery-Cottet reports a relationship with Arthrex Inc that includes royalties and consulting.
Georg Brandl reports a relationship with Arthrex Inc that includes consulting or advisory.
Patrick A. Smith reports a relationship with Arthrex Inc that includes consulting, research grants, royalties, and intellectual property.
Gordon Mackay reports a relationship with Arthrex Inc that includes consulting and royalties (InternalBraceTM).
Clemens Kösters reports a relationship with Mathys Medical that includes medical advisor.
Adnan Saithna reports a relationship with Arthrex Inc that includes consulting; and further: AANA Committee, OJSM Editorial Board, ISAKOS Committee.
Wolf Petersen, reports a relationship with Karl Storz that includes consultancy fees; OPED: Consultancy fees; Arthrex: Lecture fees; Plasmoconcept: Lecture fees.
Stefan Eggli, reports a relationship with Mathys Orthopedic LTD that includes consulting.

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Article info

Publication history

Published online: April 04, 2023
Accepted: March 28, 2023
Received: November 18, 2022

Identification

DOI: https://doi.org/10.1016/j.jisako.2023.03.434

Copyright

© 2023 The Authors. Published by Elsevier Inc. on behalf of International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine.

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