ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics
Abstract Background Anterior cruciate ligament (ACL) reconstruction remains the gold standard but carries donor-site morbidity and prolonged recovery. Modern ACL repair techniques theoretically preserve native proprioception and enable faster rehabilitation. We hypothesized that modern ACL repair wo...
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2025-08-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-025-03101-6 |
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| author | Hongcheng Zheng Yongtao Zeng Nacke Daoerji Husen Wang Bin Tang Li Shu |
| author_facet | Hongcheng Zheng Yongtao Zeng Nacke Daoerji Husen Wang Bin Tang Li Shu |
| author_sort | Hongcheng Zheng |
| collection | DOAJ |
| description | Abstract Background Anterior cruciate ligament (ACL) reconstruction remains the gold standard but carries donor-site morbidity and prolonged recovery. Modern ACL repair techniques theoretically preserve native proprioception and enable faster rehabilitation. We hypothesized that modern ACL repair would demonstrate non-inferior clinical outcomes compared to reconstruction.This meta-analysis compares clinical outcomes of primary repair versus autograft reconstruction. Methods We systematically searched PubMed, Cochrane Library, and Web of Science (2015–2025) for comparative studies (RCTs, cohorts, case-controls) reporting ≥ 2 key outcomes (failure rate, AP knee laxity, IKDC, Lysholm, or Tegner scores) with ≥ 1-year follow-up. Pooled ORs and WMDs with 95% CIs were calculated using RevMan 5.4. Subgroup analyses (injury-to-surgery time, injury location, study design, repair technique) and GRADE assessment were performed. Results Fourteen studies (4 RCTs, 8 cohorts, 2 case-controls; n = 908 patients) were included (repair: n = 460; reconstruction: n = 448). Failure/Revision Rates: Repair demonstrated numerically higher failure rates (OR = 2.24, 95% CI 1.30–3.86, P = 0.004) and revision rates (OR = 2.01, 95% CI 1.21–3.33, P = 0.007) versus reconstruction.Hardware removal: increased hardware removal incidence was observed in repair groups (OR = 8.19, 95% CI 2.89–23.20, P < 0.001).AP knee laxity: reconstruction showed marginally lower AP knee laxity (WMD = 0.30, 95% CI 0.06–0.53, P = 0.01).Patient-reported outcomes: no significant differences in IKDC (WMD = 1.31,95%CI: −0.01–2.63;P = 0.05) or Tegner scores (WMD: 0.01; 95% CI: -0.28– 0.30;P = 0.94). Lysholm scores slightly favored reconstruction (WMD = 1.62,; 95% CI: 0.35–2.89;P = 0.01).Key subgroup findings: repair achieved comparable outcomes to reconstruction in: (1) RCT-designed studies, (2) Acute repairs (< 21 days post-injury). Conclusions ACL repair is associated with higher failure and revision rates than reconstruction overall, but may be a viable alternative in selected patients with acute proximal tears. |
| format | Article |
| id | doaj-art-3fcd6d2d52164b06bcaddb3ca8a5b7b0 |
| institution | Kabale University |
| issn | 1471-2482 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Surgery |
| spelling | doaj-art-3fcd6d2d52164b06bcaddb3ca8a5b7b02025-08-20T04:01:47ZengBMCBMC Surgery1471-24822025-08-0125111110.1186/s12893-025-03101-6ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristicsHongcheng Zheng0Yongtao Zeng1Nacke Daoerji2Husen Wang3Bin Tang4Li Shu5The Sixth Affiliated Hospital of Xinjiang Medical UniversityThe Sixth Affiliated Hospital of Xinjiang Medical UniversityThe Sixth Affiliated Hospital of Xinjiang Medical UniversityThe Sixth Affiliated Hospital of Xinjiang Medical UniversityThe Sixth Affiliated Hospital of Xinjiang Medical UniversityThe Sixth Affiliated Hospital of Xinjiang Medical UniversityAbstract Background Anterior cruciate ligament (ACL) reconstruction remains the gold standard but carries donor-site morbidity and prolonged recovery. Modern ACL repair techniques theoretically preserve native proprioception and enable faster rehabilitation. We hypothesized that modern ACL repair would demonstrate non-inferior clinical outcomes compared to reconstruction.This meta-analysis compares clinical outcomes of primary repair versus autograft reconstruction. Methods We systematically searched PubMed, Cochrane Library, and Web of Science (2015–2025) for comparative studies (RCTs, cohorts, case-controls) reporting ≥ 2 key outcomes (failure rate, AP knee laxity, IKDC, Lysholm, or Tegner scores) with ≥ 1-year follow-up. Pooled ORs and WMDs with 95% CIs were calculated using RevMan 5.4. Subgroup analyses (injury-to-surgery time, injury location, study design, repair technique) and GRADE assessment were performed. Results Fourteen studies (4 RCTs, 8 cohorts, 2 case-controls; n = 908 patients) were included (repair: n = 460; reconstruction: n = 448). Failure/Revision Rates: Repair demonstrated numerically higher failure rates (OR = 2.24, 95% CI 1.30–3.86, P = 0.004) and revision rates (OR = 2.01, 95% CI 1.21–3.33, P = 0.007) versus reconstruction.Hardware removal: increased hardware removal incidence was observed in repair groups (OR = 8.19, 95% CI 2.89–23.20, P < 0.001).AP knee laxity: reconstruction showed marginally lower AP knee laxity (WMD = 0.30, 95% CI 0.06–0.53, P = 0.01).Patient-reported outcomes: no significant differences in IKDC (WMD = 1.31,95%CI: −0.01–2.63;P = 0.05) or Tegner scores (WMD: 0.01; 95% CI: -0.28– 0.30;P = 0.94). Lysholm scores slightly favored reconstruction (WMD = 1.62,; 95% CI: 0.35–2.89;P = 0.01).Key subgroup findings: repair achieved comparable outcomes to reconstruction in: (1) RCT-designed studies, (2) Acute repairs (< 21 days post-injury). Conclusions ACL repair is associated with higher failure and revision rates than reconstruction overall, but may be a viable alternative in selected patients with acute proximal tears.https://doi.org/10.1186/s12893-025-03101-6Anterior cruciate ligamentRepairReconstructionMeta-analysisAcute proximal injury |
| spellingShingle | Hongcheng Zheng Yongtao Zeng Nacke Daoerji Husen Wang Bin Tang Li Shu ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics BMC Surgery Anterior cruciate ligament Repair Reconstruction Meta-analysis Acute proximal injury |
| title | ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics |
| title_full | ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics |
| title_fullStr | ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics |
| title_full_unstemmed | ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics |
| title_short | ACL repair vs. reconstruction: a meta-analysis of outcomes across different tear characteristics |
| title_sort | acl repair vs reconstruction a meta analysis of outcomes across different tear characteristics |
| topic | Anterior cruciate ligament Repair Reconstruction Meta-analysis Acute proximal injury |
| url | https://doi.org/10.1186/s12893-025-03101-6 |
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