🦵 TYPES OF ACL REPAIR & RECONSTRUCTION TECHNIQUES

🔹 Primary ACL Repair (Direct Repair)

Definition: Reattachment of the torn native ACL to its femoral or tibial footprint, preserving the original ligament.

Indications:

Proximal (femoral-sided) tears

Good tissue quality

Often in acute injuries (<3 weeks old)

Techniques:

Suture anchor repair (reattaching ACL to femoral wall)

Suture augmentation/internal brace (using FiberTape or similar to protect repair during healing)

Examples:

Arthroscopic primary ACL repair with suture anchors (e.g., “BEAR,” “InternalBrace”)

🔹 Biologic-Enhanced ACL Repair

Definition: Augmenting primary repair with biological scaffolds to improve healing.

Types:

BEAR (Bridge-Enhanced ACL Repair): Uses a collagen scaffold saturated with autologous blood to bridge torn ends.

Stem cell or PRP-assisted repair: Under research; aims to enhance ligament healing biologically.

🔹 ACL Reconstruction (Graft-Based Replacement)

When native ACL cannot be repaired (most common), a graft is used to reconstruct it.

a. Autograft Reconstruction

Using patient’s own tissue:

Hamstring tendon graft (most common)

Bone–Patellar Tendon–Bone (BPTB) graft

Quadriceps tendon graft

Each has different pros/cons:

Graft Advantages Disadvantages

Hamstring Smaller incision, less anterior knee pain Slower graft incorporation

BPTB Bone-to-bone healing, strong fixation Anterior knee pain, kneeling discomfort

Quadriceps Good graft size, less donor-site pain May cause temporary extensor weakness

b. Allograft Reconstruction

Uses donor tissue (e.g., Achilles, tibialis anterior)

Pros: shorter surgery, no donor morbidity

Cons: slower incorporation, higher re-tear rate (especially in young athletes)

🔹 Hybrid Techniques

Combination of repair and reconstruction — for example:

Augmented repair + partial graft if some ACL fibers remain intact.

ACL remnant-preserving reconstruction to retain proprioceptive fibers.

🔹 Dynamic Intraligamentary Stabilization (DIS)

Technique: Uses a dynamic spring screw (e.g., Ligamys system) to stabilize ACL during healing.

Goal: Promotes natural healing while preventing anterior tibial translation.