Anterior Cruciate Ligament Repair Back to the Future?

Anterior cruciate ligament (ACL) repair is a procedure that has been used to treat torn ACLs dating back to the early 1900s. With unpredictable outcomes of repair, a paradigm shift led to surgeons to opt for ACL reconstruction as a new gold standard, as the evidence showed a more reliable outcome. However, there has been a recent resurgence in ACL repair worthy of review, particularly in proximal avulsions. Suture anchor repair is one repair technique in which recent studies show low failure rates, low reoperation rates, and favorable clinical outcomes. More recent data supports augmenting this strategy with suture tape. An innovation in ACL repair techniques is the Bridge-Enhanced ACL Repair (BEAR) technique, which combines a patient's whole blood with a collagen-based scaffold to augment the repair. While promising results have been shown with these techniques, narrow indications are necessary for a successful ACL repair.