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, 6 (5), e1529-e1534
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Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation

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Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation

Jelle P van der List et al. Arthrosc Tech.

Abstract

Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. In hindsight, however, appropriate patient selection (i.e. proximal tears and good tissue quality) was not performed, because it has recently been recognized that good outcomes of primary ACL repair are possible when selectively performed in patients with proximal tears and good tissue quality. Moreover, with modern-day advances, arthroscopic primary repair can be an excellent treatment option for patients with proximal tears. Preserving the native ACL has several advantages, including maintaining native proprioceptive function and biology. The procedure is also minimally invasive and prevents the need for formal ACL reconstruction. Recently, it has been suggested that additional suture augmentation of the primary repair technique may be beneficial for protecting ligament healing during early range of motion. In this Technical Note, we present the surgical technique of arthroscopic primary repair with suture augmentation for patients with proximal ACL tears.

Figures

Fig 1
Fig 1
(A) Arthroscopic view of a right knee, viewed from the anterolateral portal with the patient supine and the knee in 90° flexion. The anterior cruciate ligament is shown with a type I avulsion tear (asterisk) and an intact distal and middle part of the ligament with excellent tissue quality and vascularity (arrowhead). (B) Arthroscopic view of a right knee, viewed from the anterolateral portal with the patient supine and the knee in 90° flexion. A suture passer (arrowhead) is used to pass a No. 2 FiberWire suture through the anteromedial bundle. The suture is passed in an alternating, interlocking Bunnell-type pattern and advancing proximally when compared with the previous stitches (arrow). In the left top corner of the image, the No. 2 TigerWire sutures of the posterolateral bundle are seen (asterisk), because these were performed first in this patient.
Fig 2
Fig 2
(A) Arthroscopic view of a right knee, viewed from the anterolateral portal with the patient supine and the knee in 90° flexion. Sutures are passed through both the anteromedial bundle (arrowhead) and posterolateral bundle (arrow). In the left top corner of the image, the femoral footprint can be seen, which has been roughened to induce a healing response (asterisk). (B) Arthroscopic view of a right knee, viewed from the anterolateral portal with the patient supine and the knee in 90° flexion. The suture anchor of the anteromedial bundle is deployed in the anteromedial region within the femoral footprint (arrow). The arrowheads show the FiberTape suture augmentation. In the left bottom corner of the image, the sutures of the posterolateral bundle can be seen (asterisk).
Fig 3
Fig 3
(A) Arthroscopic view of a right knee, viewed from the anterolateral portal with the patient supine and the knee in 90° flexion. The suture anchor of the anteromedial bundle with the suture augmentation (asterisk) has been deployed in the femoral footprint. A micro suture lasso (arrow) with channel sutures (arrowhead) is used to channel the suture augmentation (asterisk) through the drilled tibial tunnel. (B) Arthroscopic view of a right knee, viewed from the anterolateral portal with the patient supine and the knee in 90° flexion. A completed primary repair of the anterior cruciate ligament reinserting both the anteromedial bundle (asterisk) and the posterolateral bundle (arrowhead) into the anatomic femoral footprint can be seen. The suture augmentation (arrow) is channeled along the ligament and provides stability in the early phases of rehabilitation, and thus enables early range of motion and fast recovery.

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References

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