Anterior Cruciate Ligament (ACL) injuries are among the most common sports-related injuries, especially in athletes participating in pivot-heavy sports like soccer, basketball, and football. Traditionally, the gold standard for treating a torn ACL has been ACL reconstruction, where the damaged ligament is replaced with a graft, typically taken from the patient’s patellar tendon, hamstring, or a donor. However, in recent years, ACL repair—a technique focused on preserving and repairing the native ligament—has gained traction as a viable alternative in select cases.
What is ACL Repair?
Unlike reconstruction, which replaces the torn ligament, ACL repair involves reattaching the torn ends of the ligament, sometimes using suture anchors or augmentation devices. This approach is primarily suitable for proximal tears, where the ligament detaches from the femoral origin, and the tissue remains of good quality.
New techniques, such as Bridge-Enhanced ACL Repair (BEAR), have enhanced the viability of repairs. The BEAR technique uses a collagen scaffold to promote natural healing, combining the repair with biologics like the patient's own blood to support regeneration.
Benefits of ACL Repair
One of the most significant benefits of ACL repair is the preservation of the native ligament. This is crucial because the ACL contains proprioceptive fibers—nerve endings that help with balance and coordination. Preserving these fibers may result in better neuromuscular control and faster return to sport.
Other advantages include:
Less invasive procedure: ACL repair typically involves less drilling and tissue harvesting, leading to a faster recovery and reduced postoperative pain.
Quicker rehabilitation: Because the native ligament is preserved, patients often regain strength and mobility more quickly than those undergoing reconstruction.
No graft harvest morbidity: Reconstruction often requires harvesting tendons from other parts of the body, which can cause pain, weakness, or complications at the donor site—issues avoided with repair.
Lower risk of osteoarthritis: Some early studies suggest that preserving the natural ACL may reduce long-term joint degeneration compared to reconstruction.
Comparing ACL Repair and Reconstruction
Despite these benefits, ACL reconstruction remains the gold standard, especially for mid-substance tears, chronic injuries, or patients with poor tissue quality. Reconstruction has decades of long-term data supporting its success, with reliable outcomes and low re-tear rates in properly selected patients.
On the other hand, ACL repair, while promising, is still evolving. Patient selection is critical; the success of repair hinges on the tear type, location, and tissue integrity. Current data suggest that in ideal candidates, repair can match or even outperform reconstruction in short-term outcomes, though long-term durability remains under investigation.
Conclusion
ACL repair is an exciting development in sports medicine that offers a less invasive alternative with several potential benefits, including faster recovery, preservation of proprioception, and reduced donor site complications. However, it is not suitable for all types of ACL injuries. For now, ACL reconstruction remains the gold standard, but with continued innovation and research, repair techniques may soon redefine how we approach these common injuries.
Andrew Hayden, MD
Sports Medicine Specialist & Orthopedic Surgeon
Halifax Health | UF Health Orthopedics & Sports Medicine
Offices in Deltona and Daytona Beach
Appointments: 386.457.6480
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