Retensionable Anchor Repair of Proximal Anterior Cruciate Ligament Avulsion

Anterior cruciate ligament (ACL) repair has historically shown high failure rates, particularly in young athletes, limiting its use compared with reconstruction. However, select proximal avulsion injuries (Sherman type 1) with healthy ligament tissue offer an opportunity for repair. This study describes an arthroscopic repair technique using retensionable suture anchors for precise ligament tensioning in full extension, potentially reducing postoperative laxity. The technique includes dual-anchor fixation, intraoperative retensioning, and augmentation with a bridge-enhanced ACL repair (BEAR) implant to promote healing within the hostile intra-articular environment. This approach may address limitations of ACL repair by improving mechanical stability and optimizing biological conditions for healing. Further studies are needed to assess long-term outcomes and cost-effectiveness, but it offers a promising option in appropriately selected patients.