A Head-to-Head Comparison of Outcomes of ACL Reconstruction vs. ACL Repair

Few studies have directly compared the effectiveness of anterior cruciate ligament (ACL) reconstruction with that of ACL repair, a less-invasive but less commonly performed procedure to treat a torn ACL.

A retrospective analysis presented at the American Orthopaedic Society of Sports Medicine’s Annual Meeting 2022 adds to the literature on the topic, with the researchers finding that patients in their study who underwent ACL repair had better outcomes than those who underwent ACL reconstruction.

Study Methodology

The researchers evaluated clinical and functional outcomes for 150 patients, 75 patients in the ACL repair group and 75 in the ACL reconstruction group. Patient were matched according to:

  • Age
  • Gender
  • BMI
  • Time between injury and surgery
  • Knee laxity parameters
  • Presence of meniscal lesions
  • Preoperative activity level
  • Sports participation

The minimum follow-up period was 2 years.

Isokinetic testing was used to evaluate strength deficits compared with the contralateral limb at 6 months postoperatively. At the final follow-up visit, surgeons recorded:

  • Knee laxity parameters
  • Return to sport
  • Outcome measures: Lysholm, Tegner, IKDC, ACL-RSI, and Forgotten Joint Score-12 (FJS)

Study Findings

Patients in the ACL repair group had significantly better mean hamstring muscle strength on the operative versus the contralateral leg compared with their counterparts who underwent ACL reconstruction (P<0.0001).

At a mean final follow-up of 30 +/- 4.8 months, the ACL repair group had significantly better FJS than the ACL reconstruction group (P=0.017). No significant differences were observed between groups for the Lysholm, Tegner, and ACL-RSI scores. The ACL repair group met non-inferiority criteria for subjective IKDC scores and knee laxity parameters (side-to-side anteroposterior laxity difference and pivot shift) when compared with the ACL reconstruction group.

No significant differences were observed in the rate of return to the pre-injury level of the sport: 74.7% for the ACL repair group vs 60% for the reconstruction group (P=0.078). However, a significant difference was observed with the occurrence of ACL re-rupture, with a failure rate of 5.3% for ACL repair vs 0% for ACL reconstruction (P=0.045).

Patients experiencing failure of the ACL repair were significantly younger than those whose repair did not fail, 26.8 years vs 40.7 years, respectively (P=0.013). No significant difference in rupture rates was observed between groups when only patients older than age 22 were considered (P=0.157)

Summarizing the data, study author Adnan Saithna, MD, FAANA, from Arizona Brain, Spine & Sports Injuries Center in Scottsdale, said that “ACL repair was associated with significantly better isokinetic strength tests at 6 months, better FJS at final follow-up, and non-inferior IKDC, Lysholm, Tegner, ACL-RSI, and knee laxity parameters. However, the rate of re-rupture was significantly higher when compared to ACL reconstruction, and younger patients were particularly at risk.”


Saithna A, et al. Clinical Outcomes of ACL Reconstruction vs ACL Repair: A Matched-Pair Analysis (Paper 83). Presented at the American Orthopaedic Society of Sports Medicine’s Annual Meeting 2022, July 13-17, 2022, Colorado Springs, Colorado.

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