Is ACL Repair Really Back? A Review of Modern Techniques

Anterior cruciate ligament (ACL) repair has been suggested to have several potential advantages over ACL reconstruction (ACLR) including preservation of both the native anatomy and the proprioceptive function of the knee. The initial open surgical techniques of ACL repair fell out of favor due to the limited success and unpredictability of the results. There has been a renewed interest in ACL repair given its biomechanical advantages, the advent of new arthroscopic surgical techniques, modern repair technology (implants and biological adjuncts), and perhaps a better understanding of which tear patterns may be more amenable to successful repair. More recently, ACL repair has been shown to be most successful in patients with proximal ACL tears and good tissue quality, as well as with the ability to biologically augment the repair. Midterm follow-up of these patients have promising outcomes in regards to patient satisfaction, stability, and return to work or sport. Broadly, the different ACL repair techniques include internal augmentation, enhancement of the biologic environment, and the use of secure femoral-sided footprint fixation. This article aims to summarize these studies and review the different techniques for ACL repair that have been described in the literature.