Utoyo Ghuna Arioharjo, Hidayat Yudi Mulyana, Rahim Agus Hadian, Usman Hermin Aminah, Dirgantara Tatacipta, Adachi Nobuo, Calvin Calvin
Department of Orthopaedics and Traumatology, Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia.
Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Knee Surg Sports Traumatol Arthrosc. 2025 Jun 5. doi: 10.1002/ksa.12715.
To compare the failure rates, complications and patient-reported outcome measures (PROMs) between arthroscopic anterior cruciate ligament (ACL) repair and reconstruction (ACLR) for acute ACL rupture.
A search was conducted on MEDLINE, ScienceDirect, Scopus and Cochrane Library. Clinical studies reporting failure rates, complications or PROMs between ACL repair and ACLR with a minimum of 2-year follow-up period were included. The complications evaluated were residual knee laxity, subsequent secondary meniscus injury, scar-related complications, other knee-related complications and hardware removal rates. The PROMs evaluated were the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner score, Lysholm score and ACL-Return to Sport after Injury (ACL-RSI) scale. Subgroup analyses were conducted to evaluate the influence of repair techniques and surgical timing.
Fourteen studies were included, with 565 patients in the ACL repair group and 684 patients in the ACLR group. The meta-analysis demonstrated that ACL repair results in a significantly higher failure rate (p = 0.006) and greater residual knee laxity (p < 0.0001) compared to ACLR. No significant differences were found in subsequent secondary meniscus injury, scar-related complications, other knee-related complications and hardware removal rates. In terms of PROMs, ACL repair demonstrated higher IKDC and Lysholm scores, comparable KOOS and Tegner score, but a significantly lower ACL-RSI scores (p = 0.02) compared to ACLR. Subgroup analysis by surgical timing indicated that repairs performed with an interval of ≤3 weeks produce similar failure rates (p = 0.33) but exhibit greater residual laxity (p = 0.006) compared to ACLR, whereas those >3 weeks showed both significantly higher failure rates (p = 0.01) and greater residual laxity (p = 0.001).
Arthroscopic repair performed more than 3 weeks after the initial injury was associated with a higher failure rate and greater residual laxity compared to ACLR.
Level III, meta-analysis.
比较关节镜下急性前交叉韧带（ACL）损伤修复与重建（ACLR）的失败率、并发症及患者报告的结局指标（PROMs）。
检索MEDLINE、ScienceDirect、Scopus和Cochrane图书馆。纳入报告ACL修复与ACLR之间失败率、并发症或PROMs且随访期至少2年的临床研究。评估的并发症包括膝关节残留松弛度、继发半月板损伤、瘢痕相关并发症、其他膝关节相关并发症及内固定取出率。评估的PROMs包括国际膝关节文献委员会（IKDC）评分、膝关节损伤和骨关节炎结局评分（KOOS）、Tegner评分、Lysholm评分及ACL损伤后恢复运动（ACL-RSI）量表。进行亚组分析以评估修复技术和手术时机的影响。
纳入14项研究，ACL修复组565例患者，ACLR组684例患者。荟萃分析表明，与ACLR相比，ACL修复的失败率显著更高（p = 0.006），膝关节残留松弛度更大（p < 0.0001）。继发半月板损伤、瘢痕相关并发症、其他膝关节相关并发症及内固定取出率无显著差异。在PROMs方面，与ACLR相比，ACL修复的IKDC和Lysholm评分更高，KOOS和Tegner评分相当，但ACL-RSI评分显著更低（p = 0.02）。按手术时机进行的亚组分析表明，间隔≤3周进行的修复与ACLR相比失败率相似（p = 0.33），但残留松弛度更大（p = 0.006），而间隔>3周的修复失败率显著更高（p = 0.01），残留松弛度也更大（p = 0.001）。
与ACLR相比，初次损伤3周后进行的关节镜修复失败率更高，残留松弛度更大。
III级，荟萃分析。
