ACL Repair

There has been a renewed interest in ACL primary repairs as the treatment for Sherman Type I and Type II ACL ruptures. Careful analysis of historical data has revealed that certain ACL tear subgroups, especially proximal tears with good tissue quality, have positive clinical outcomes with primary ACL repair.1

Studies reporting outcomes of remnant-preserving ACL surgeries have shown encouraging results and a greater potential for early healing and better functional outcomes compared with remnant-resecting surgeries.2 Preservation of the native ACL using the primary repair technique can achieve short-term clinical success and result in good clinical outcomes at 3-year follow-up in this carefully selected patient population.3

Arthroscopic primary repair is minimally invasive in that no grafts need to be harvested, no tunnels need to be drilled, and revision surgery, if necessary, is more analogous to primary reconstructions.4 The goal of the procedure is to preserve the remnant native ligament. By doing this, the native nerve endings and blood supply are preserved.5

References

1. van der List JP, DiFelice GS. Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: a systematic review of historical studies. Knee. 2017;24(5):898-908. doi:10.1016/j.knee.2017.05.009

2. van der List JP, DiFelice GS. Successful arthroscopic primary repair of a chronic anterior cruciate ligament tear 11 years following injury. HSS J. 2017;13(1):90-95. doi:10.1007/s11420-016-9530-8

3. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):21-28. doi:10.1007/s00167-018-5338-z

4. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 2015;31(11):2162-2171. doi:10.1016/j.arthro.2015.08.010

5. DiFelice GS, van der List JP. Arthroscopic primary repair of proximal anterior cruciate ligament tears. Arthrosc Tech. 2016;5(5):e1057-e1061. doi:10.1016/j.eats.2016.05.009

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There has been a renewed interest in ACL primary repairs as the treatment for Sherman Type I and Type II ACL ruptures. Careful analysis of historical data has revealed that certain ACL tear subgroups, especially proximal tears with good tissue quality, have positive clinical outcomes with primary ACL repair.1

Studies reporting outcomes of remnant-preserving ACL surgeries have shown encouraging results and a greater potential for early healing and better functional outcomes compared with remnant-resecting surgeries.2 Preservation of the native ACL using the primary repair technique can achieve short-term clinical success and result in good clinical outcomes at 3-year follow-up in this carefully selected patient population.3

Arthroscopic primary repair is minimally invasive in that no grafts need to be harvested, no tunnels need to be drilled, and revision surgery, if necessary, is more analogous to primary reconstructions.4 The goal of the procedure is to preserve the remnant native ligament. By doing this, the native nerve endings and blood supply are preserved.5

References

1. van der List JP, DiFelice GS. Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: a systematic review of historical studies. Knee. 2017;24(5):898-908. doi:10.1016/j.knee.2017.05.009

2. van der List JP, DiFelice GS. Successful arthroscopic primary repair of a chronic anterior cruciate ligament tear 11 years following injury. HSS J. 2017;13(1):90-95. doi:10.1007/s11420-016-9530-8

3. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):21-28. doi:10.1007/s00167-018-5338-z

4. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 2015;31(11):2162-2171. doi:10.1016/j.arthro.2015.08.010

5. DiFelice GS, van der List JP. Arthroscopic primary repair of proximal anterior cruciate ligament tears. Arthrosc Tech. 2016;5(5):e1057-e1061. doi:10.1016/j.eats.2016.05.009

View More

Educational Resources and Products

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ACL Repair TightRope® Surgical Technique Animation

Surgical Technique Animations | 04:10 | English | 12/09/2021 | AN1-000324-en-US A
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ACL Primary Repair Using the ACL Repair TightRope® Implant and FiberRing™ Sutures

Patrick A. Smith, MD
Surgical Technique Videos | 17:37 | English | 06/20/2022 | VID1-003199-en-US A
ACL Preservation With the ACL Repair TightRope® Implant
Surgical Technique Guides | English | 10/06/2021 | LT1-000229-en-US A
ACL Preservation With the SwiveLock® ACL Repair Kit
Surgical Technique Animations | 03:27 | English | 11/09/2020 | AN1-000224-en-US A
ACL Primary Repair Using the InternalBrace™ Technique
Gregory S. DiFelice, MD
Surgical Technique Videos | 11:48 | English | 11/29/2021 | VID1-01061-en-US D
SwiveLock® ACL Primary Repair Implant System
Surgical Technique Guides | English | 09/28/2021 | LT1-000174-en-US D
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Surgical Technique Videos (12)

ACL Preservation Using the ACL Repair TightRope® Implant and FiberRing™ Sutures
Aravind Athiviraham, MD
08:40 | English | 01/31/2023 | VID1-003709-en-US A
PCL Primary Repair Using the PCL Repair TightRope® Implant and FiberRing™ Sutures
Gregory S. DiFelice, MD
15:24 | English | 06/29/2022 | VID1-003066-en-US B
ACL Primary Repair Using the ACL Repair TightRope® Implant and FiberRing™ Sutures
Patrick A. Smith, MD
17:37 | English | 06/20/2022 | VID1-003199-en-US A
Tibial Spine Avulsion Fracture Reduction Using ACL Repair TightRope® Implant and FiberRing™ Suture
Rachel M. Frank, MD
12:16 | English | 12/20/2021 | VID1-002908-en-US A
ACL Primary Repair Using the InternalBrace™ Technique
Gregory S. DiFelice, MD
11:48 | English | 11/29/2021 | VID1-01061-en-US D
ACL Primary Repair Using the InternalBrace™ Technique
Gordon Mackay, MD
09:11 | English | 11/24/2021 | VID1-0151-en-US B
ACL Preservation With the TightRope® Fixation System
Michael P. Bradley, MD, MS
06:49 | English | 11/09/2021 | VID1-000112-en-US D
ACL Primary Repair With InternalBrace™ Ligament Augmentation and AlloSync™ Demineralized Bone Matrix Augmentation
Patrick A. Smith, MD
09:58 | English | 10/25/2021 | VID1-000101-en-US B
ACL Primary Repair Using the SwiveLock® ACL Repair Implant System
Gregory S. DiFelice, MD
Surgical Technique Videos | 18:50 | English | 05/19/2021 | VID1-002212-en-US A
Primary ACL Repair with Arthrex Amnion™ Matrix
Babak Samimi, MD
Surgical Technique Videos | 07:01 | English | 11/22/2017 | VID1-01110-EN A
ACL Preservation with Central Augmentation Using the FlipCutter® and TightRope® RT
Gregory S. DiFelice, MD
Surgical Technique Videos | 18:22 | English | 10/09/2014 | VID1-00178-EN A
ACL Primary Repair with SwiveLock®
Gregory S. DiFelice, MD
Surgical Technique Videos | 15:05 | English | 02/21/2014 | VID1-00092-EN A

Surgical Technique Animations (2)

ACL Repair TightRope® Surgical Technique Animation
04:10 | English | 12/09/2021 | AN1-000324-en-US A
ACL Preservation With the SwiveLock® ACL Repair Kit
03:27 | English | 11/09/2020 | AN1-000224-en-US A

Surgical Technique Guides (4)

ACL-Erhalt mit dem ACL Repair TightRope®
German | 03/14/2022 | LT1-000229-de-DE A
ACL Preservation With the ACL Repair TightRope® Implant
English | 10/06/2021 | LT1-000229-en-US A
SwiveLock® ACL Primary Repair Implant System
English | 09/28/2021 | LT1-000174-en-US D
Reparación primaria del LCA
Spanish | 08/22/2014 | LT1-0151-ES A

510Ks (1)

510K Arthrex TightRope II
English | 05/13/2021 | K202581 A

Brochures (1)

Strength, Speed, and Versatility for Graft Preparation
English | 09/07/2022 | LB1-00140-EN B

Case Presentation Videos (2)

ACL Preservation: Techniques and Outcomes
Gregory S. DiFelice, MD
11:39 | English | 01/12/2022 | VID1-002881-en-US A
NanoScope™ Operative Arthroscopy System - ACL Repair of a Femoral Avulsion in a Young Adult
Thomas M. DeBerardino, MD
05:58 | English | 06/03/2020 | VID1-000762-en-US A

Coding Guides (1)

2023 Coding and Reimbursement Guidelines for the SwiveLock® ACL Repair Kit
English | 02/27/2023 | OF1-000345-en-US F

Orthopedia.com Video Links (1)

ACL Tears: Literature Review on Primary ACL Repair
English | 02/21/2022 | LINK_VID1-003207-en-US A

Outcomes Reports (1)

ACL Repair with InternalBrace™ Ligament Augmentation
English | 10/28/2021 | CC1-00025-EN F

Presentation Videos (8)

ACL Preservation: Early Experience
Gregory S. DiFelice, MD
14:52 | English | 11/23/2021 | VPT1-00539-en-US B
The Future is Now! The InternalBrace™ Technique
Michael G. Baraga, MD
08:14 | English | 10/14/2021 | VID1-002874-en-US A
Primary Anterior Cruciate Ligament (ACL) Repair with InternalBrace™ Ligament Augmentation
Wiemi A. Douoguih, MD
15:44 | English | 02/19/2018 | VPT1-01013-EN B
ACL Repair with Augmentation
Professor Adrian Wilson, BSC, FRCS, MBBS
12:12 | English | 07/11/2017 | VPT1-00801-EN B
ACL Primary Repair: My Technique Using Suture Anchors
Gregory S. DiFelice, MD
05:21 | English | 06/15/2017 | VPT1-00827-EN A
ACL Repair with InternalBrace™ Ligament Augmentation
Wiemi A. Douoguih, MD
06:04 | English | 03/30/2017 | VPT1-00800-EN A
ACL Preservation
Gregory S. DiFelice, MD
13:37 | English | 04/01/2016 | VPT1-00632-EN A
Primary ACL Repair
Gregory S. DiFelice, MD
24:11 | English | 02/28/2014 | VPT1-00195-EN A

Product Demonstrations (2)

Graft Preparation Using the GraftLink® Technique With the ACL TightRope® II Implant and SutureTape
J. Lee Pace, MD
10:19 | English | 12/12/2022 | VID1-003667-en-US A
MPFL Graft Preparation Using FiberLoop® SutureTape
J. Lee Pace, MD
10:54 | English | 12/09/2022 | VID1-003666-en-US A

Product and Technique Highlights (2)

ACL Repair TightRope® Implant
English | 10/19/2021 | DOC1-000588-en-US A
SwiveLock® ACL Repair Kit
English | 08/23/2021 | DOC1-000526-en-US B

SOS Graphs (2)

ACL Repair with InternalBrace™ Ligament Augmentation vs. ACL Reconstruction up to Two Years Follow-up
English | 10/17/2022 | DOC1-000178-en-US D
ACL Repair with InternalBrace™ Ligament Augmentation
English | 07/07/2020 | DOC1-000239-en-US A

Scientific Updates (2)

ACL Primary Repair Scientific Update: A Review of Modern Techniques
English | 06/07/2022 | LA1-00055-EN M
InternalBrace™ Technique: Knee Applications
English | 06/03/2022 | DOC1-000161-en-US G

Surgeon Newsletters (1)

Scope This Out - Volume 22, Number 2
English | 08/09/2021 | LN1-000351-en A

Testimonials (3)

ACL Primary Repair Using the InternalBrace™ Technique Gets Runner Back on the Trail
Gregory S. DiFelice, MD
03:15 | English | 11/21/2022 | VID1-000009-en-US E
ACL Preservation: A Unique Case Report of ACL Primary Repair Using the InternalBrace™ Technique
Gregory S. DiFelice, MD
03:49 | English | 07/11/2021 | VID1-000619-en-US B
Alpine Skier Makes an Olympic Comeback Thanks to Arthrex Innovation
Bertrand Sonnery-Cottet, MD
03:31 | English | 12/26/2018 | VID1-01464-EN A

Video Series (1)

BreakThrough™ with Christopher Adams, MD - Episode 10: ACL Primary Repair
Christopher Adams, MD | Gregory S. DiFelice, MD | Bertrand Sonnery-Cottet, MD | Wiemi A. Douoguih, MD
25:09 | English | 04/25/2018 | VID1-01331-EN B

AR-1594

Implant System, ACL Repair with BioComposite SwiveLock

AR-1588R-IB

ACL Repair TightRope, with InternalBrace

AR-1588TB-IB

ACL InternalBrace Ligament Augmentation Button

AR-7282-25

FiberRing with Shuttle Loop 25mm, Box of 12

AR-7282-35

FiberRing with Shuttle Loop 35mm, Box of 12

AR-7282-45

FiberRing with Shuttle Loop 45mm, Box of 12

AR-7282-55

FiberRing with Shuttle Loop 55mm, Box of 12

AR-1593-P

Implant System, Secondary Fixation with PEEK SwiveLock Anchor 4.75 x 19.1 mm

AR-1593-BC

Implant System, Secondary Fixation with BioComposite SwiveLock Anchor 4.75 x 19.1 mm

AR-1593

Implant System, Secondary Fixation with 4.75 mm BioComposite SwiveLock,ACL/PCL Repair

AR-6592-08-20

PassPort Button Cannula, 8 mm ID x 2 cm, qty 5

AR-7535

FiberLink SutureTape, 1.3 mm, with Loop (White/Blue), 12/box

AR-1595TC

ACL TightRope, Drill Pin, Closed Eyelet

AR-1900S

ACL ToolBox Instrument Set

AR-1510S

RetroConstruction Drill Guide System Instrument Set

AR-1510FD-24

2.4 mm, Ratchet Drill Sleeve

AR-1594D-24

2.4 mm Cannulated Drill and SutureLasso SD Wire Loop

AR-1204FF

FlipCutter III Drill

AR-1595T

ACL TightRope, Drill Pin, Open Eyelet, 4 mm

AR-1250F

Drill Tip Guide Pin, 3.5 mm

AR-1250FS

Drill Tip Guide Pin 3.5 mm x 311 mm

AR-13999MF

FastPass Scorpion SL Suture Passer

AR-8150PX-45

PowerPick, 45° 6 mm Drill Depth

AR-13970NR

KingFisher Suture Retriever/Tissue Grasper with NR Handle

AR-13974NR

FiberTape Retriever with NR Handle, Non-Ratcheting

AR-16794L

Suture Cutter, 4.2 mm x 220 mm, Open Ended, Left Notch

AR-1927D

Drill Spade Tip, for 5.5 mm Corkscrew FT and 4.75 mm and 5.5 mm SwiveLock

AR-1218-40

Drill, 4 mm Cannulated

AR-1218-45

Drill, 4.5 mm Cannulated

AR-7209SNT

#2 FiberSnare suture, 26" length with 2” closed loop (Black/White)

AR-7209SNL

#2 FiberSnare suture, 26" length with 2” closed loop (White/Blue)

AR-7209SN

FiberSnare, #2 FiberWire, 26", (green), stiffened w/Closed Loop 12"

AR-7237

FiberTape, 2 mm, 36 in (Blue) each end Tapered to #2 FiberWire

AR-7501

SutureTape, x-pattern, 1.3 mm, two each 40 in Strands (1 White/Blue, 1 White/Black), 12/Box

AR-7535T

FiberLink SutureTape, 1.3 mm, with Loop (White/Black), 12/box

AR-7538

FiberLink SutureTape , 1.7 mm, (White/Blue), with Closed Loop, 12/Box

AR-7538T

TigerLink SutureTape, 1.7 mm, (White/Black), with Closed Loop, 12/Box

AR-7535

FiberLink SutureTape, 1.3 mm, with Loop (White/Blue), 12/box

AR-7524

SutureTape Loop, 0.9 mm with Straight Needles, (White/Blue)

AR-7524-1

SutureTape Loop, 0.9 mm with Straight Needles, (White/Blue)

AR-7571-02

SutureTape, 0.9 mm, 38 inches, with two 36.6 mm Half Curved Tapered Needles, (White/Blue)

AR-7571-02-1

SutureTape, 0.9 mm, with 36.6 mm Curved Needles, (White/Blue)

AR-7546-02

SutureTape, 1.3 mm, with 2 Straight Needles, (White/Blue)

AR-7546-02-1

SutureTape, 1.3 mm, with two Straight Needles, (White/Blue)

AR-7546TT-02

SutureTape, 1.3 mm, with two Straight Needles, (Black/White)

AR-7546TT-02-1

SutureTape, 1.3 mm, with two Straight Needles, (Black/White)

AR-7505

SutureTape, 1.3 mm, with two 26.5 mm Curved Needles, (White/Blue)

AR-7505-1

SutureTape, 1.3 mm, with two 26.5 mm Curved Needles, (White/Blue)

AR-7505TT-02

SutureTape, 1.3 mm, with two Curved Needles, (Black/White)

AR-7505TT-02-1

SutureTape, 1.3 mm, with two Curved Needles, (Black/White)

AR-7531-02

SutureTape, 1.3 mm, with two Curved 36.6 mm Needles, (White/Black)

AR-7531-02-1

SutureTape, 1.3 mm, with two 36.6 mm Curved Needles, (White/Black)

AR-7570-02

SutureTape, 0.9 mm, with two 22.2 mm Curved Needles, (White/Blue)

AR-7570-02-1

SutureTape, 0.9 mm, with two 22.2 mm Curved Needles, (White/Blue)

AR-7209SNL

#2 FiberSnare suture, 26" length with 2” closed loop (White/Blue)

AR-7209SNL-1

#2 FiberSnare with #2 FiberWire Braided Polyblend Suture, (White/Blue) with Closed Loop, 66 cm, One End Stiffened, 30 cm

AR-7209SNT

#2 FiberSnare suture, 26" length with 2” closed loop (Black/White)

AR-7209SNT-1

#2 FiberSnare with #2 FiberWire Braided Polyblend Suture, (Black/White) with Closed Loop, 66 cm, One End Stiffened, 30 cm

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