Primary ACL Repair Revisited: Back to the Future?

Primary repair of the Anterior Cruciate Ligament (ACL) had some popularity among a select group of surgeons in the mid 20(th) century. Techniques described by Ivar Palmer of Sweden were adopted in the United States by surgeons such as O’Donoghue, Marshall, and Feagin. However, promising early results were followed by disappointing failure rates at 5-year follow-up, and ACL reconstruction became the norm. Recently there has been a renewed interest in ACL repair. One use has been in conjunction with ACL reconstruction as remnant preservation. Isolated repair has been reported using a variety of techniques, including bridge-enhanced repair (BEAR) with a sheath, meticulous suturing with or without suture tape reinforcement, and repair to a dynamic intraligamentary stabilization (DIS) device. Early reports have been encouraging. However, in the case of the BEAR, the series is so far small and short-term; the two other techniques have more results reported but they include some studies with a concerning level of failure, especially in younger or more active patients. My current recommendation is to await more clinical documentation before adopting these technique in lieu of ACL reconstruction.