What did the study look at?
The usual treatment for an anterior cruciate ligament (ACL) injury is to rebuild the ligament with another tendon (reconstruction). According to the authors, repairing the patient's own ligament (ACL repair) has re-emerged as an option for suitable patients. The reasons given are that it restores the patient's own anatomy, keeps the fibres that give the knee its sense of position (proprioceptive fibres) and avoids problems at a graft donor site.
For tears close to the thigh bone in particular, adding a tape alongside the repaired ligament (internal brace) has been thought to reinforce the ligament and act as a secondary stabiliser. This article presents the technique through one patient.
How was it done?
This is a surgical technique article based on a video of the operation; it is not a study comparing results across a group of patients.
The patient in the video felt a "pop" in the knee while doing jumping jacks and had five months of soreness, swelling and the knee giving way. Non-operative treatment had not helped. Examination tests indicated ligament insufficiency, and MRI showed that the ligament had pulled away from its attachment on the thigh bone, together with a tear at the back of the inner meniscus.
The main steps described are:
- Arthroscopy confirms that the ligament has torn from the thigh bone; the ligament remnant is preserved, and microfracture is performed at the attachment site to support healing.
- Interlocking sutures are passed through both bundles of the ligament, from the intact lower end towards the torn upper end.
- A hole is made at the ligament's natural attachment on the thigh bone, and the sutures are fixed there with an anchor preloaded with the internal brace tape.
- A tunnel is drilled at the ligament's natural attachment on the shin bone; the tape is passed through it and fixed to the surface of the shin bone with an anchor.
The post-operative plan includes six weeks without weight-bearing, followed by physiotherapy and a return to activities at six to eight months.
What did it find?
The article does not present outcome data for this patient. The authors state that within two years of surgery, patients are expected to show improved knee-specific quality of life, stability and return to activities. Citing earlier publications, they also summarise that:
- Early case reports described good function and a healed ligament.
- Biomechanical studies showed higher load to failure, stiffness and energy to failure.
- Some reports found significantly higher early failure rates after tape-augmented repair compared with standard reconstruction, particularly in adolescents.
As technical points, the authors highlight preserving the ligament remnant, using an interlocking suture pattern, placing the tunnels at the natural attachment sites and avoiding over-tensioning the tape.
The authors' conclusion
The authors conclude that a growing understanding of the ACL should prompt surgeons to consider augmented repair techniques in selected patients with tears close to the thigh bone, with the aim of improving outcomes and restoring the natural anatomy.
Limitations
- The article demonstrates the technique in a single patient and does not report that patient's post-operative results.
- The authors note that published results have not been uniformly favourable, and that careful patient selection and longer-term outcome data are needed.
Reference
Vadhera AS, Kumar R, Alnemri AG, Swindell H, Gürsoy S, Singh H, Khan ZA, Verma NN, Chahla J. (2025). Anterior Cruciate Ligament Repair With Internal Bracing Augmentation. Video Journal of Sports Medicine, 5(6): 26350254251349548. Licence: CC BY-NC-ND 4.0.
DOI: 10.1177/26350254251349548
Free full text: PubMed Central (PMC12623611)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
