Acute Anterior Cruciate Ligament Tear Surgery: Repair Versus Reconstruction – When?

Decision making regarding treatment of a patient with an acute injury to the anterior cruciate ligament (ACL) requires careful consideration of the individual patient together with the latest evidence. While nonoperative measures are appropriate for low-demand older patients and those willing to modify their activities, many patients are treated surgically each year in an attempt to restore stability and function to the knee. The patient’s age, skeletal maturity, concomitant injuries, level of activity, and functional goals must be assessed in choosing a particular procedure. In addition, the type of ACL injury (complete vs. partial) and location of the tear (proximal vs. midsubstance vs. distal) must also be determined by physical exam and imaging to make a decision regarding the best treatment. The current evidence supports both ACL reconstruction and repair as viable options in select patient populations in specific situations. Overall, operative management of ACL injuries restores stability to the knee allowing patients to return to activities. While ACL reconstruction is considered by many as the “gold standard,” advances in basic science research over the past decade have offered new options for marrow stimulation and primary repair. In addition, continued clinical research will help determine the long-term outcomes and consequences of each type of treatment.