Primary ACL repair has limited adoption among experts: Perspectives from the 2024 Freddie Fu Panther Sports Medicine Symposium.

PURPOSE: To provide a commentary on the indications and current state of anterior cruciate ligament (ACL) repair versus ACL reconstruction (ACLR), utilising a case-based discussion among a group of international Orthopaedic surgeons at the 2024 Freddie Fu Panther Sports Medicine Symposium.

METHODS

An electronically distributed survey was provided to participants of the 2024 Freddie Fu Panther Sports Medicine Symposium during the meeting with questions regarding their indications for a primary ACL repair and their views on rehabilitation, return to sport, and complications after ACL repair. Three cases were discussed, the results of the surveys were recorded, and a post-case discussion followed to reach a consensus during the case resolutions.

RESULTS

Fifty-nine participants replied to the surveys during the symposium's 'Repair versus Reconstruction' session. For acute, complete, proximal ACL tears (modified Sherman classification I) in active patients older than 50 years, 34% of the participants would treat nonoperatively, 61% of the participants would treat with ACLR, and 5% of the participants would treat with primary ACL repair. For the same case in a 17-year-old patient, 3% of the participants would treat non-operatively, 90% of the participants would treat with ACLR, and 7% of the participants would treat with primary ACL repair. Bone-patellar tendon-bone autograft was most commonly selected for young patients (51%), while allografts were used in older patients (13.5%), and synthetic grafts were rarely considered.

CONCLUSION

Consensus was achieved on ACLR as the standard of care for young patients (90%). Treatment choices in patients over 50 years were more variable (61% ACLR, 34% non-operative and 5% ACL repair). Based on the survey results, ACL repair remains a procedure with limited indications. Future clinical research is necessary to understand long-term clinical outcomes of ACL repair and to compare the clinical efficacy of ACL repair with ACLR or non-operative treatment.

LEVEL OF EVIDENCE: Level V.