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Updated: Sep 25, 2025

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ACL repair for athletes?

Anshu Shekhar1, Anoop Pilar2, K M Ponnanna3

  • 1Arthroscopy and Arthroplasty Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.

Journal of Orthopaedics
|April 25, 2022
PubMed
Summary

Anterior cruciate ligament (ACL) suture repair offers potential benefits over traditional reconstruction but requires more evidence. Athletes need proven faster recovery and lower re-tear rates before ACL repair becomes standard practice.

Keywords:
ACL ReconstructionACL RepairAnterior cruciate ligamentAthletesReturn to sports

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Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Biomaterials science

Background:

  • Arthroscopic anterior cruciate ligament (ACL) reconstruction with autografts is the standard for athletes but has complications like graft re-tear and donor site morbidity.
  • ACL suture repair (ACLSR) presents an alternative surgical approach, potentially preserving native ACL biology and proprioception.
  • ACLSR aims to improve knee stability, reduce kinesiophobia, and expedite rehabilitation compared to traditional reconstruction.

Purpose of the Study:

  • To evaluate the current evidence supporting ACL suture repair (ACLSR) as a viable alternative to ACL reconstruction in athletes.
  • To assess the purported benefits of ACLSR, including native tissue preservation and improved patient outcomes.
  • To identify the limitations and evidence gaps in the existing literature on ACLSR, particularly for athletic populations.

Main Methods:

  • Review of existing literature on ACLSR, including case series, cohort studies, and randomized controlled trials.
  • Analysis of studies focusing on patient-reported outcome measures and short-term results.
  • Evaluation of the consistency and independent validation of reported outcomes across different ACLSR techniques.

Main Results:

  • Existing literature on ACLSR shows encouraging but limited results, often based on small numbers and short-term follow-up.
  • Outcome measures are predominantly patient-reported, and studies are frequently conducted by the technique's originators, lacking independent validation.
  • Inconsistent results across studies and a lack of specific data for athletic populations hinder definitive conclusions.

Conclusions:

  • Insufficient evidence currently supports recommending ACLSR as a preferred treatment for acute proximal ACL tears in athletes.
  • Further research is required to demonstrate improved return-to-sport rates, reduced re-tear incidence, and decreased kinesiophobia in athletes undergoing ACLSR.
  • Independent, large-scale studies are needed to validate the efficacy and safety of ACLSR in athletic populations.