Role of primary anterior cruciate ligament repair with or without augmentation.

Primary ACL repair with or without extra-articular augmentation can be functionally and statically successful based on our experience in high-performance athletes. Proper surgical technique, appropriate rehabilitation, and excellent quality of the tissue being repaired are required to achieve these results. Several notable improvements in diagnostic imaging, physical examination, surgical technique, and rehabilitation protocol have led to excellent results. The notchplasty, multiple loop suture technique, and improved meniscal repair are key factors. Moreover, we believe that one of the prime enhancements is to provide the highly stable extra-articular lateral capsular ligament reconstruction described previously. Laboratory findings have shown that this procedure provides excellent support against anterior subluxation immediately after surgery. It appears that release of the iliotibial band tissue proximally prevents stretching and failure of this extra-articular procedure. Rehabilitation unquestionably is a critical factor in the success of this surgical procedure. Immediate motion and appropriate biomechanical stresses on the repaired ligament have proved compatible with good functional and objective results. Even though intra-articular reconstruction of the torn ACL continues to be considered the gold standard, we remain convinced that primary repair of the ACL with appropriate extra-articular augmentation should not be ruled out in many cases. This procedure clearly is a viable, successful, and acceptable alternative to intra-articular reconstruction in selected cases.