CORR Insights®: Is Primary Arthroscopic Repair Using the Pulley Technique an Effective Treatment for Partial Proximal ACL Tears?

摘要

The idea of suture-repairing the native tissues of the ACL fell from favor in the 1990s because the historic outcomes of open repair techniques were marginal at best. A large number of patients had recurrent laxity as a result of the nonselective repair approach (all tear types were repaired), in addition to high rates of stiffness and patellofemoral pain due to the open approach that was followed by casting. The conclusion that the ACL couldn’t heal due to poor blood supply was printed in textbooks and taught to residents across the world, myself included, as reconstructive techniques supplanted suture repairs. However, as many recent studies suggest [1, 4, 6-8], it seems that it is not that the ACL can’t heal, but more likely that only certain types of tears (proximal) have a higher likelihood of healing [1, 4, 6-8, 14, 15]. In the days of open ACL repair, many surgeons realized that their patients with proximal tears seemed to do better [15]. Applying modern diagnostic technology, arthroscopic surgical techniques, and modern rehabilitation principles to the ACL injury problem has led to the concept that perhaps we can selectively repair proximal ACL tears, which have a better potential to heal [14]. This concept, combined with some honest reporting about the limitations of reconstruction [3, 18], has led to an explosion of interest in ACL repair techniques [1, 4, 6-8].