Anterior Cruciate Ligament Repair: Historical Perspective, Indications, Techniques, and Outcomes

Anterior cruciate ligament (ACL) repair was first reported in 1895 by Sir Arthur Mayo-Robson. Open primary ACL repair was performed throughout the 1970s and 1980s; however, rerupture rates were as high as 50% at mid-term follow-up. Throughout the 1980s and 1990s, synthetic graft materials received consideration; however, the outcomes were abysmal. Recently, with a better understanding of ACL healing and improvement in technique, there has been renewed interest in ACL repair. The potential advantages of ACL repair include improvements in knee kinematics and proprioception, avoiding graft harvest, and preserving bone stock. Although recent data on short-term outcomes suggest potential in properly indicated patients, medium- and long-term outcomes are largely unknown. ACL repair has the greatest potential in cases of proximal ACL rupture (modified Sherman type I and II proximal tears). Repair of midsubstance tears (modified Sherman type III tears) should be avoided. Caution is advised in athletes and younger patients because of higher failure rates. Today, ACL repair remains controversial and should be performed with caution because of limited medium- and long-term outcomes.