Primary Repair Combined with Bone Marrow Stimulation in Acute Anterior Cruciate Ligament Lesions

Abstract

Background The anterior cruciate ligament has been shown to have poor healing ability, and reconstruction is the standard treatment. Hypothesis Primary anterior cruciate ligament repair combined with bone marrow stimulation could restore stability and function in athletes with acute anterior cruciate ligament incomplete tears. Study Design Case series; Level of evidence, 4. Methods Among a group of 99 patients with clinically diagnosed anterior cruciate ligament acute lesions, 26 athletes with arthroscopically confirmed incomplete anterior cruciate ligament proximal tears were treated with primary repair combined with bone marrow stimulation of the anterior cruciate ligament femoral attachment site. Postoperatively, all patients underwent a specific rehabilitation program. All patients were prospectively evaluated; outcome measures were assessed using Marx, Noyes, Tegner, Single Assessment Numeric Evaluation, Lysholm, and International Knee Documentation Committee scores. Anterior tibial translation was measured using Rolimeter instrument under anesthesia and at final follow-up. Results All athletes were followed up for a mean 25.3 months (range, 17-38 months). Mean age was 26.6 years. Mean preinjury Tegner was 7.1 (SD, 1.1) and final Tegner 6.7 (SD, 1.4); mean preinjury Marx was 11.0 (SD, 3.4) and final Marx 9.6 (SD, 3.1); mean preinjury Noyes was 82.5 (SD, 5.8) and final Noyes 83.3 (SD, 7.2). These scores were not statistically different at P values of. 020,. 011, and. 303, respectively. Final Single Assessment Numeric Evaluation rating was significantly lower than was preinjury Single Assessment Numeric Evaluation rating. This was mainly related to decreased self-confidence in high-risk sports and fear of new injury. Final Single Assessment Numeric Evaluation rating and Tegner scores were significantly higher than were their respective preoperative values. Mean Rolimeter side-to-side difference of anterior knee translation was significantly reduced from 3.5 mm (SD, 0.7) preoperatively to 1.3 mm (SD, 0.8) postoperatively. Conclusion In this athletic population, anterior cruciate ligament primary repair in acute incomplete lesion combined with bone marrow stimulation effectively restored knee stability and function.