Arthroscopic Anterior Cruciate Ligament Re-Repair Using Internal Brace Augmentation – A Case Report

INTRODUCTION: Anterior cruciate ligament (ACL) tears are among the most common orthopedic injuries. In the demanding athletic patient, autograft ACL reconstruction is recognized as the gold standard treatment. However, there is a renewed interest in the preservation and repair of the torn ACL. Despite good to excellent clinical short-to mid-termresults of ACL primary repair, there are currently no reports of a successful secondary ACL repair following a retear of a primary ACL repair. CASE REPORT: We report the successful secondary ACL repair of a 47-year-old athletic female patient who initially fell while skiing, suffering a left proximal ACL tear that was subsequently treated with an arthroscopic ACL repair using internal brace augmentation. The patient was administered to intensive post-operative physiotherapy and aquatic therapy as well as continuous follow-up visits where the pain-free patient demonstrated a full range of motion with negative Lachman, Drawer, and pivot shift tests. Ten weeks postoperatively, the patient returned to sports – including alpine skiing 3 months postoperatively. Just 1 week after, her 1-year follow-upvisit, the patient experienced another severe ski fall suffering a proximal ACL retear to her left knee. She underwent arthroscopic ACL repair using internal brace augmentation on the same day. The patient returned to sports 10-week post-injury and demonstrated a full range of knee motion, negative Lachman, Drawer, and pivot shift tests with a 1.0mm side-to-side laxity difference at 12-month follow-up with good subjective outcome parameters: International Knee Documentation Committee score of 83, Lysholm score of 95, and a pre-and post-operative Tegner score of 7. Again, she returned to alpine skiing 3 months postoperatively. CONCLUSION: Arthroscopic ACL re-repair using internal brace augmentation is feasible and provides objective and subjective short-term clinical success as a revision surgery for primary ACL repair with internal brace augmentation. However, critical patient selection – including assessment of the ACL retear pattern and tissue quality – and prompt surgery are essential.