Thank you. Our senior author has one disclosure, he serves as a consultant for Arthrex. No other authors have any relevant disclosures. So ACL repair has regained popularity most recently. Historically open primary repair was the surgery of choice to address this and no surgery augmentation was available or used. Unfortunately this data was plagued with a high failure rate and poor outcomes almost universally except in a few certain circumstances and those included the proximal femoral wall avulsions and the very proximal tears, Sherman type one and two tears. Since this we've developed many new techniques and kind of decided what our indications are for primary repair and up to this point few groups have reported failure rates and outcomes of contemporary approaches thus we thought it was a worthwhile study. To report patient reported outcome measures and failure rates of a consecutive series of patients that underwent primary suture repair that were augmented for both Sherman type one and two tears by a single surgeon. We hypothesized that these primary repairs had an acceptable failure rate and would have improved patient reported outcome measures as compared to the preoperative state. During the enrollment period which started in January of 2014 and ended in June 2016 we had 28 patients that were retrospectively evaluated. We excluded patients with any multi ligamentous knee injury. We evaluated patients by a variety of patient reported outcome measures which included KOS, WOMAC, the visual analog scale for pain, VR12, the marks activity score, SANE, failures and reoperations all assessed and we used a simple two-tailed student's t-test to compare pre and post-op scores with P less than .05 considered statistically significant. To briefly touch on the technique the proximal avulsion is peeled off of the lateral intercondylar notch, a degree of micro fracture with a power pick is undertaken, the avulsed ligament is whip stitched with a fiber wire and proximal fixation is with an extra cortical suspensory fixation distally it's fixed with a 4.75 swivel lock. Probably the repaired ligament and the internal brace are tensioned separately so as to not over constrain the internal brace. So we had a very high rate of follow up at 96%, 27 of the 28 patients were available. Pretty young cohort, just shy of 30 years of age, two-thirds of these patients were male, followed them for around three years. Out of 27 patients, four failed and underwent a subsequent revision to ACL reconstruction. To look at the outcomes of patients that did not fail, the KOS, the physical VR12, the SANE score and WOMAC all significantly improved. Of note, the mental VR12 did improve but it was not of any statistical significance. Looking at pain, also improved, the Marks Activity Scale improved as well but it was not statistically significant. So to conclude on our findings, there's a low rate of clinical failure without burning any bridges for future reconstruction in the future when looking at primary repair with suture augmentation for these proximal femoral wall avulsion ACL tears. There's a significant improvement in KOS, physical VR12, SANE, WOMAC and pain. This agrees with other contemporary literature regarding similar techniques in repair with suture augmentation and we've seen just in our anecdotal experience that strict indications likely lead to better outcomes. Thank you.

ACL repair surgery

primary suture repair

proximal femoral wall avulsion ACL tears

failure rates

patient-reported outcomes