Editorial Commentary: Preservation of the Ruptured Anterior Cruciate Ligament - Evidence of Ligamentous Maturation following Primary Repair.

The long-standing belief that the anterior cruciate ligament (ACL) cannot be successfully repaired to achieve subsequent healing is increasingly being challenged by emerging clinical and imaging evidence. Recent studies have demonstrated favorable short- to mid-term outcomes following selective, arthroscopic ACL primary repair, particularly in the setting of proximal tears with good or excellent tissue quality. MRI follow-up indicates progressive ligamentous maturation and remodeling during the first two years postoperatively, supporting the notion of sufficient biological healing potential with preservation of tissue integrity in selected cases. Clinically, patients undergoing primary repair have demonstrated excellent patient-reported outcomes, as well as preservation of anterior knee stability with comparable results achieved following ACL reconstruction in certain populations. Moreover, primary repair offers several reported potential advantages as it preserves the native ACL, avoids autograft harvesting and tunnel drilling, and maintains proprioceptive function - all while reestablishing biomechanical stability. By bridging the gap between nonoperative treatment and reconstruction techniques, ACL primary repair should be part of an individualized, injury-specific, patient-centered treatment strategy.

VIVO Weill Cornell Medical College