Editorial Commentary: Primary Anterior Cruciate Ligament Repair Is Back-But Younger Age Remains a Risk Factor:...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biologics

Background:

• Primary anterior cruciate ligament (ACL) repair is gaining traction as an alternative to reconstruction.
• Advances in surgical techniques and biologics support tissue preservation.
• Unanswered questions persist regarding optimal patient selection, timing, and adjunct procedures.

Purpose of the Study:

• To review the current evidence and evolving role of primary ACL repair.
• To identify key factors influencing the success of ACL repair.
• To discuss the challenges in defining the precise role of ACL repair in treatment algorithms.

Main Methods:

• Review of case series and noncomparative studies on primary ACL repair.
• Analysis of outcomes including return-to-sport rates and short-term survivorship.
• Evaluation of patient selection criteria, surgical timing, and adjunctive procedures.

Main Results:

• Carefully selected patients with acute proximal ACL tears demonstrate high return-to-sport rates and acceptable short-term survivorship with primary repair.
• Expeditious surgical treatment is common for eligible patients to prevent tissue degeneration.
• Success is contingent on strict inclusion criteria, patient age, activity level, and the use of augmentative procedures.

Conclusions:

• Primary ACL repair is a viable option for carefully selected patients.
• Surgeons must balance innovation with caution, considering the "who, when, and how" of surgical decisions.
• Defining the exact role of primary ACL repair in modern ACL treatment algorithms is an ongoing challenge.