Are The Results of Arthroscopic Primary Repair for Proximal Anterior Cruciate Ligament Rupture Comparable to Reconstruction Technique? A Systematic Review and Meta-Analysis

Objectives: With the advancement in tissue engineering and regenerative medicine, there has been a resurgence of interest in the anterior cruciate ligament (ACL) repair technique. Compared to ACL reconstruction, repair offers several advantages, including: less damage, no donor site complications, preservation of proprioception, and earlier function restoration. The primary objective of our study is to compare the clinical outcomes of ACL repair to ACL reconstruction. The secondary aim is to compare the rate of complications between these two techniques. Methods: PubMed, Cochrane and Google Scholar were searched for relevant studies published from January 2016 to July 2024. Inclusion criteria consisted of: (1) comparative studies (randomized controlled trials or cohorts) that compare patients treated with the ACL repair technique to ACLR reconstruction; (2) written in English. Exclusion criteria consisted of: (1) case series, systematic review, meta-analysis, cadaveric studies, and animal studies; (2) non-relevant studies reports. Results: Sixteen studies were included (1,350 patients, consisting of 589 in the ACL repair group and 761 in the ACL reconstruction group). IKDC score (p = 0.04) and Lysholm score (p = 0.03) were found to be significantly higher in the ACL repair group, while no significant differences were found for the Tegner scale (p = 0.85). Side-to-side differences in knee laxity were significantly higher in the ACL repair group (p = 0.03). No significant differences were found for the incidence of graft rupture, failure, or non-functioning (p = 0.13); occurrence of secondary meniscus injury (p = 0.56); stiffness or scar tissue requiring surgery (p = 0.41); and overall reoperation rate (p = 0.10) between these two groups. Conclusion: In terms of clinical outcomes, ACL repair appears to provide more superior outcomes compared to ACL reconstruction. However, the ACL repair group was associated with higher side-to-side differences in knee laxity. In terms of complications, no significant differences were found between these groups. Further high-quality comparative studies are still needed because data from the current existing studies are still considered to be inadequate.