Arthroscopic primary repair of the anterior cruciate ligament: Rationale, patient selection and early outcomes

In this thesis we have investigated the possibility and results of a new procedure to treat tears of the anterior cruciate ligament (ACL). ACL injuries are common injuries in the athletic and younger population, and generally patients with these injuries are either treated nonoperatively or treated with a reconstruction of the ligament in which the original ACL is removed and replaced by one of the tendons that are harvested. We have also investigated the possibility of repairing the torn ACL and thus preserving the native ligament with its proprioception and not requiring the harvesting of tendon grafts, which have donor site morbidity and result in a more invasive procedure.
We noticed that this procedure might have been abandoned prematurely for all patients in the twentieth century, and that some patients might benefit from this procedure. These are patients with proximal tears in which most of the ligament is remained intact, but it completely torn off the insertion site, and they should be treated in the more acute setting. We have also found that patients with these tears could be identified preoperatively on MRI. Finally, we have reviewed the outcomes of this procedure in the short- and mid-term and reviewed the outcomes that have been reported in the literature and noted encouraging outcomes of this procedure. At the end of this thesis we present the protocol of a multicenter randomized trial that will be performed in the Netherlands in which we will compare the outcomes of ACL repair and reconstruction.