Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is need
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Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is needed: a systematic review and meta‑analysis of recent literature Jelle P. van der List1,2,3 · Harmen D. Vermeijden1,3 · Inger N. Sierevelt1,2 · Gregory S. DiFelice3 · Arthur van Noort1 · Gino M. M. J. Kerkhoffs2,4,5 Received: 4 June 2019 / Accepted: 26 August 2019 © The Author(s) 2019
Abstract Purpose To assess the outcomes of the various techniques of primary repair of proximal anterior cruciate ligament (ACL) tears in the recent literature using a systematic review with meta-analysis. Methods PRISMA guidelines were followed. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears using primary repair, repair with static (suture) augmentation and dynamic augmentation between January 2014 and July 2019 in PubMed, Embase and Cochrane were identified and included. Primary outcomes were failure rates and reoperation rates, and secondary outcomes were patient-reported outcome scores. Results A total of 13 studies and 1,101 patients (mean age 31 years, mean follow-up 2.1 years, 60% male) were included. Nearly all studies were retrospective studies without a control group and only one randomized study was identified. Grade of recommendation for primary repair was weak. There were 9 out of 74 failures following primary repair (10%), 6 out of 69 following repair with static augmentation (7%) and 106 out of 958 following dynamic augmentation (11%). Repair with dynamic augmentation had more reoperations (99; 10%), and more hardware removal (255; 29%) compared to the other procedures. All functional outcome scores were > 85% of maximum scores. Conclusions This systematic review with meta-analysis found that the different techniques of primary repair are safe with failure rates of 7–11%, no complications and functional outcome scores of > 85% of maximum scores. There was a high risk of bias and follow-up was short with 2.1 years. Prospective studies comparing the outcomes to ACL reconstruction with sufficient follow-up are needed prior to widespread implementation. Level of evidence IV.
Introduction * Jelle P. van der List [email protected] 1
Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
2
Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
3
Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
4
Amsterdam UMC, Academic Center for Evidence Based Sports Medicine (ACES), University of Amsterdam, Amsterdam, The Netherlands
5
Amsterdam UMC, Amsterdam Collaboration On Health and Safety in Sports (ACHSS), University of Amsterdam, IOC Research Center, Amsterdam, The Netherlands
Over the last year, there has been a renewed interest in the concept of primary repair of the anterior cruciate ligament (ACL) [76]. Open primary repair was commonly performed in the twentieth century and, despite promising short-term results [12, 21, 49, 5
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