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Biological Augmentation of ACL Refixation in Partial Lesions in a Group of Athletes: Results at the 5-Year Follow-up

Gobbi, Alberto MD; Karnatzikos, Georgios MD; Sankineani, Sukesh R. MD; Petrera, Massimo MD

doi: 10.1097/BTO.0b013e318294ce44
Invited Review Articles

Anterior cruciate ligament (ACL) reconstruction is the current gold standard treatment for ACL lesions; however, higher complication rates in adolescents, loss of proprioception, donor side morbidity, and incomplete return to high-risk sports are potential pitfalls of this procedure. Recent studies have shown that the healing ability of the ruptured ligament can be enhanced by growth factors and bone marrow–derived multipotent mesenchymal stem cells. A primary ACL repair technique offers potential advantages including the preservation of the proprioceptive functions of the ligament and lower harvest site morbidity. Our study included a group of 50 athletes treated with primary ACL repair combined with bone marrow stimulation and growth factors at the 5-year follow-up. The final follow-up showed 78% of the patients returning to their sports activities, a significant decrease in the side-to-side difference in anterior translation (4.1 mm preoperatively to 1.4 mm postoperatively, P<0.05), a significant improvement in the postoperative Tegner (P<0.05) and the Single Assessment Numeric Evaluation scores (P<0.05). Final Marx and Noyes scores were similar to preinjury values and the final IKDC objective was as follows: normal (A) in 39 patients; nearly normal (B) in 10 patients; and severely abnormal (D) in 1 patient (2%). Re-tear of the repaired ligament was seen in 4 patients, and 1 patient had residual laxity resulting in a survival rate of 90% at the 5-year follow-up.

Our study demonstrated that this surgical technique of ACL primary repair utilized in selected patients with acute partial ACL lesions can offer good clinical outcomes.

OASI (Orthopaedic Arthroscopic Surgery International) Bioresearch Foundation, Gobbi N.P.O., Milan, Italy

A.G. is a scientific consultant for Harvest Technologies Ltd, Piramal Healthcare Pvt Limited, Canada. He does not receive any royalties and stock options. The remaining authors declare that they have nothing to disclose.

Address correspondence and reprint requests to Alberto Gobbi, MD, OASI (Orthopaedic Arthroscopic Surgery International) Bioresearch Foundation, Gobbi N.P.O., Via GA Amadeo 24, Milan 20133, Italy. E-mail:

© 2013 by Lippincott Williams & Wilkins