Arthroscopic Anterior Cruciate Ligament Re-Repair Using Internal Brace Augmentation - A Case Report

Anterior cruciate ligament (ACL) tears are among the most common orthopedic injuries. In the demanding athletic patient, autograft ACL reconstruction is recognized as the gold standard treatment. However, there is a renewed interest in the preservation and repair of the torn ACL. Despite good to excellent clinical short-to mid-termresults of ACL primary repair, there are currently no reports of a successful secondary ACL repair following a retear of a primary ACL repair.

We report the successful secondary ACL repair of a 47-year-old athletic female patient who initially fell while skiing, suffering a left proximal ACL tear that was subsequently treated with an arthroscopic ACL repair using internal brace augmentation. The patient was administered to intensive post-operative physiotherapy and aquatic therapy as well as continuous follow-up visits where the pain-free patient demonstrated a full range of motion with negative Lachman, Drawer, and pivot shift tests. Ten weeks postoperatively, the patient returned to sports - including alpine skiing 3 months postoperatively. Just 1 week after, her 1-year follow-upvisit, the patient experienced another severe ski fall suffering a proximal ACL retear to her left knee. She underwent arthroscopic ACL repair using internal brace augmentation on the same day. The patient returned to sports 10-week post-injury and demonstrated a full range of knee motion, negative Lachman, Drawer, and pivot shift tests with a 1.0mm side-to-side laxity difference at 12-month follow-up with good subjective outcome parameters: International Knee Documentation Committee score of 83, Lysholm score of 95, and a pre-and post-operative Tegner score of 7. Again, she returned to alpine skiing 3 months postoperatively.

Arthroscopic ACL re-repair using internal brace augmentation is feasible and provides objective and subjective short-term clinical success as a revision surgery for primary ACL repair with internal brace augmentation. However, critical patient selection - including assessment of the ACL retear pattern and tissue quality - and prompt surgery are essential.