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Outcome of ACL knee repair versus reconstruction

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Knee repair surgery may be easier than reconstruction, but experts say the longer procedure is sometimes necessary. Miniseries/Getty Images
  • Researchers say that people who undergo knee repair surgery tend to have better outcomes than those who undergo knee reconstruction surgery.
  • Experts, however, say the choice between the two operations is not always straightforward and sometimes more intensive reconstructive surgery is needed.
  • They note that recovery time can vary with either procedure.

Tom Melhuish knows the difference between anterior cruciate ligament (ACL) reconstruction surgery and ACL knee repair surgery.

He was unlucky to have both.

The UK resident got the first one when a defender landed on his knee while spinning during a football game. He tore his ACL, dislocated his knee and tore his meniscus.

During reconstructive surgery, doctors replaced his tendon with one from his hamstring. The recovery process took 11 months.

Just months after returning to football, Melhuish tore the anterior cruciate ligament in his reconstructed knee. His doctors simply fixed it. He was back in action 5 months later.

“The reconstructive surgery was much more painful than the repair in terms of recovery,” Melhuish told Healthline. “The knee repair surgery was not as painful and the recovery was much faster. It was a surgical operation which did not last more than an hour.

Melhuish’s experience aligns with the results of a new study that reports that people who undergo ACL knee repair have better outcomes than people who have ACL knee reconstruction.

The research was presented this week at the 2022 annual meeting of the American Orthopedic Society of Sports Medicine.

In it, the researchers directly compared the effectiveness of ACL reconstruction with ACL repair after a minimum follow-up of at least two years.

Dr. Adnan Saithna, an orthopedic surgeon and sports medicine specialist in Arizona, and his team compared 75 matched individuals who underwent ACL repair with those who underwent ACL reconstruction during the same time period.

ACL reconstruction is a surgical replacement by grafting tissue of the anterior cruciate ligament to restore function after injury. An ACL repair is a minimally invasive procedure to reattach the torn ligament.

Study participants were matched on several variables, including:

  • age
  • genre
  • body mass index (BMI)
  • the time between injury and surgery
  • knee laxity parameters
  • the presence of meniscal lesions
  • preoperative activity level
  • and sports participation

Six months after the operation, the researchers used isokinetic tests to assess the strength between the operated knee and the unoperated one. During the study’s final follow-up, researchers measured knee laxity, return to sport, and outcome.

The researchers said the ACL repair group had significantly better recovery in terms of hamstring muscle strength compared to their counterparts who underwent ACL reconstruction.

However, the researchers did not find a significant difference between the two groups when it came to returning to pre-injury levels in sports. Additionally, ACL repair was associated with a significantly higher rate of ACL re-rupture, particularly in younger age groups.

Dr. Natasha Trentacosta, a pediatric and adult sports medicine specialist and orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, told Healthline that “to say rebuilding the ACL is more complicated than repairing it is oversimplified.

“We’ve been rebuilding the ACL more than fixing it for decades for a reason,” Trentacosta said. “Many people do well with reconstructed ACLs. But it’s not perfect. This is demonstrated by this study which highlights increased joint awareness and muscle strength deficits in ACL reconstructions compared to ACL repair.

“With an ACL repair procedure, we try to preserve the native fibers and the original properties of the ligament,” she explained. “Ideally, this will help the knee retain its proprioceptive properties, which will make the knee look more natural. By repairing the torn fibres, instead of harvesting a tendon from elsewhere on the patient, we avoid the morbidity of harvesting a graft from a patient who will cause weakness in the region.

“But that doesn’t mean ACL repair is easy,” Trentacosta added. “This is evident when looking at the literature and previous research on the subject. It fell out of favor decades ago as a treatment technique due to significantly higher re-rupture rates. However, more recent research in the field has used ways to improve and protect the previously developed repair technique using biological augmentation to reduce re-rupture rates.

Dr. Alan Beyer, orthopedic surgeon and executive medical director of the Hoag Orthopedic Institute in Southern California, told Healthline the decision to rebuild or repair was not a simple one.

“This study may be a good start, but I’m not going to let one study dictate how I’ve approached ACL repair or reconstruction over the past 40 years in practice,” Beyer said. “Many of the decisions an orthopedic surgeon has to make regarding ACL repair or reconstruction depend on many factors, many of which are based on the location of the tear and the age of the patient. It’s a decision that a surgeon should take based on his experience.

“The anatomy of the injury plays a key role in my surgical decision tree, whether to repair or reconstruct,” he added. “As for the study, I would like to know how the results of ACL repair will be in five years or if there is more risk for associated osteoarthritis conditions down the line.”

Dr. Kevin Stone, an orthopedic surgeon at the Stone Clinic in San Francisco, said patients usually have a choice of which direction to take.

“However, very few ligaments are ideal for repair alone,” he told Healthline. “The most recent papers where collagen scaffolding is added to ligament repair have shown that ligaments that are ideal for repair can be repaired, but have not shown that ligaments that are not suitable for repair are not aided by a collagen scaffold.”

“We have a long history of repairing and reconstructing anterior cruciate ligaments and have found that the best repair is for a small partial tear and the best reconstruction is using donor quadriceps tissue from a young donor,” noted Stone.

In any case, the recovery time is significant and depends on various factors.

“With just ACL repair or reconstruction, you’ll likely be on crutches for one to four weeks and then walk in a brace after that for four to six weeks before you stop the brace,” says Dr. Mark Sando , surgeon at Orthopedic Medical. Tampa Bay Group.

“Your return to sport, however, is likely seven to nine months or longer, as it takes that long to allow the graft to mature and the proper reconstruction of strength and neuromuscular control to protect the healing ligament before to resume play,” he said. Health line.

“This postoperative recovery and rehabilitation period is important and critical for both procedures and does not differ significantly between the two,” Sando added.