I'm going to discuss the failure and re-operation rates between repair and reconstruction. These are my disclosures. So as we've noticed from this meeting, there's been quite a lot of talk about ACL repair. There's a renewed interest in the possibility that we can repair proximal tears by reattaching the ligament to the femoral footprint. There's a better healing capacity that's been documented compared to mid-substance tears and better outcomes in both the historical literature and the more recent literature. The resurgence seems to be driven by the potential advantages that exist. Preservation of the native ligament and proprioception, less invasive surgery since we're not drilling any tunnels or taking any grafts. We've documented a quicker return of range of motion. There's been acceptable failure rates in smaller cohorts at the two and five-year marks. And revision surgery is quite similar to doing a primary reconstruction. However, the potential disadvantages of repair are higher failure rates in adolescents, as was recently documented by Dr. Albright in his series, and potentially overtreating patients by doing surgery in the acute setting. So the aims of this paper, to keep it simple, we're going to look at failure and re-operates for repair versus recon, trying to assess the predictors of failure in both cohorts, and assess the outcomes of revision surgery very rudimentarily. And our hypothesis was there'd be no difference between the groups. So these are our methods. Retrospective, we looked at a big group that was proximal tears or mid-substance that were reconstructed, and we assessed failure of re-operations, survivorship, predictors of failure, and revision surgery. We took 241 to start with, and then we whittled it down to 121 by taking out the people who were less than two-year follow-up, augmented repairs, or ACL reconstruction in multi-ligament injured knees, leaving us with 60 versus 61. If you look at the baseline characteristics of the folks, the ages were similar, a little on the older side, and everything was similar, except there were more females in the reconstruction group. We got to the repair group a little quicker, as would be expected, and the follow-up was a bit longer for the recon, because I wasn't doing the repair until more recently. Outcomes of surgery, failures 12% on the repair side, 16% on the recon side, re-operates 7% on the repair side, 8% on the reconstruction side, no complications with repairs, 2% on the recon, contralateral 3% versus 7% for overall re-operates of 22 and 33. The only significant variable, actually, none of them were significant, excuse me. If we did a logistic regression, what we found was the only significant predictor of failure that we could come up with was lesser age. Surgery, gender, and the length of follow-up did not show any significance. Outcomes of revision surgery, albeit the numbers are small, we wanted to look at it, no issues with the revision from the repairs. In recon, one out of three failed, re-ops were 11%, and no significant differences in that group, very small numbers. So if you look at the failure rate of primary repair, it's about 12% in this series. As the time goes by, the numbers are getting bigger, and we're getting a little more, it's getting a little more interesting, similar to smaller cohorts in the literature. Failure rate of reconstruction in this group was 16%, similar to higher in the literature. It was a mixed bag of all comers with all types of grafts, including allografts, and I will say that the follow-up on the repair was about 95%, whereas the follow-up on the recon, we're still chasing a few down, it was probably more like 65 or 70%. So we feel that that recon failure rate number is probably going to drop closer to 10%. Limitations retrospective design, we didn't really get into stability data or outcome scores, and small numbers of younger patients limit the applicability of the findings. In conclusion, we found equivalent failure and re-operation rates between both treatments. Revision, repair, surgery, similar to primary reconstruction. Primary repair seems to be a good treatment in the adult population, but obviously larger and prospective studies will be necessary to exclude potential bias and assess failure rates in younger patients. Thanks for your attention.

ACL repair

ACL reconstruction

healing capacity

ligament preservation

surgery outcomes