Arthroscopic repair for acute anterior cruciate ligament rupture results in higher failure rates and greater residual knee laxity compared to reconstruction if performed more than 3 weeks after injury: A systematic review and meta-analysis.

PURPOSE: To compare the failure rates, complications and patient-reported outcome measures (PROMs) between arthroscopic anterior cruciate ligament (ACL) repair and reconstruction (ACLR) for acute ACL rupture.

METHODS

A search was conducted on MEDLINE, ScienceDirect, Scopus and Cochrane Library. Clinical studies reporting failure rates, complications or PROMs between ACL repair and ACLR with a minimum of 2-year follow-up period were included. The complications evaluated were residual knee laxity, subsequent secondary meniscus injury, scar-related complications, other knee-related complications and hardware removal rates. The PROMs evaluated were the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner score, Lysholm score and ACL-Return to Sport after Injury (ACL-RSI) scale. Subgroup analyses were conducted to evaluate the influence of repair techniques and surgical timing.

RESULTS

Fourteen studies were included, with 565 patients in the ACL repair group and 684 patients in the ACLR group. The meta-analysis demonstrated that ACL repair results in a significantly higher failure rate (p = 0.006) and greater residual knee laxity (p < 0.0001) compared to ACLR. No significant differences were found in subsequent secondary meniscus injury, scar-related complications, other knee-related complications and hardware removal rates. In terms of PROMs, ACL repair demonstrated higher IKDC and Lysholm scores, comparable KOOS and Tegner score, but a significantly lower ACL-RSI scores (p = 0.02) compared to ACLR. Subgroup analysis by surgical timing indicated that repairs performed with an interval of ≤3 weeks produce similar failure rates (p = 0.33) but exhibit greater residual laxity (p = 0.006) compared to ACLR, whereas those >3 weeks showed both significantly higher failure rates (p = 0.01) and greater residual laxity (p = 0.001).

CONCLUSION

Arthroscopic repair performed more than 3 weeks after the initial injury was associated with a higher failure rate and greater residual laxity compared to ACLR.

LEVEL OF EVIDENCE: Level III, meta-analysis.