This study was presented at the annual meeting of the American Orthopedic Society of Sports Medicine, which took place July 13-17, 2022, in Colorado (United States).
What are the differences between ACL repair and reconstruction?
The anterior cruciate ligament contributes to knee stability. It also provides protection for the menisci. Football, skiing, handball, judo and basketball are classic examples of high-risk sports for injury to this ligament.
There are 2 ways to treat a ruptured anterior cruciate ligament:
- By reconstructionwhich is a surgical replacement by grafting tissue from the anterior cruciate ligament to restore its function after an injury;
- By repairwhich is a minimally invasive procedure to reattach the torn ligament.
Before carrying out any procedure, whether reconstruction or repair, it is important to know that it
“Never operate on a rupture of the cruciate ligament urgently, but re-examine the knee 3-4 weeks after the trauma in most cases”explains Dr Éric Plotkine, orthopedic surgeon and traumatologist at the Parisian clinic Maussins Nollet.
Patients showing laxity (looseness) in the knee after 3-4 weeks must then have surgery,
“in order to preserve the future of the knee”even more so if they are active. “On the other hand, those who do not have laxity should only continue rehabilitation with a specialist”specifies Dr Éric Plotkine.
Greater recovery with repair?
According to the study results, patients who undergo knee repair surgery tend to have better outcomes than those who undergo knee reconstruction surgery.
To do this, the researchers studied 75 people in two groups, based on their situation and similarities (age, gender, body mass index, knee laxity parameters, presence of meniscal lesions, preoperative activity level, etc.). One had undergone an ACL repair, the other a reconstruction, during the same period.
Six months after the operation, the researchers assessed the strength between the knee that had been operated on and the one that had not. During the study’s final follow-up, researchers measured knee laxity, return to sport, and outcomes.
Result: The ACL repair group had significantly better recovery in terms of hamstring muscle strength compared to their reconstruction counterparts. However, the researchers did not find a significant difference between the two groups regarding return to pre-injury sporting level.
The most common and effective procedure remains reconstruction.
Results which do not fully convince our expert, for whom the ACL reconstruction procedure remains the most common, even the most effective. “Practitioners are opting less and less for repair, in particular because it only works on high tears. If this technique worked so well, health professionals would choose it”, estimates Dr Éric Plotkine.
“The problem with repair is that it requires a rapid operation, directly after the trauma, sometimes people who do not need to be operated on. However, it is essential to wait 3 to 4 weeks before touching the anterior cruciate ligament”, he explains.
The anatomy of the injury therefore plays a key role in the surgical decision tree, to know whether to operate or not, repair or reconstruct. According to Dr. Éric Plotkine, the main factors for operating are: the patient’s laxity (data established by the doctor), instability (patient’s feelings), activity and degree of activity.
What about recovery time after an ACL tear?
Regardless of the operation undergone, the recovery and rehabilitation period is important. The patient must become active again very quickly.
Here is Dr. Éric Plotkine’s advice for gradually returning to physical activity:
- Walks directly after the operation, without splint with 2 crutches for 10 to 15 days ;
- Driving after 2 to 3 weeks
; - Return to work (office) after 2 to 4 weeks ;
- Return to work (physical or manual professional activity) after 4 to 6 weeks
- Gym (squats, exercise bike, elliptical bike), swimming (crawl, no breaststroke) after the 6th week ;
- Jogging after 3 months ;
- Pivot sports (football, skiing, tennisetc.) after 6 to 8 months.