To assess the role of preoperative magnetic resonance imaging (MRI) on the eligibility for arthroscopic primary anterior cruciate ligament (ACL) repair.
All patients undergoing ACL surgery between 2008 and 2017 were included. Patients underwent arthroscopic primary repair if sufficient tissue length and quality were present, or they underwent single-bundle ACL reconstruction. Preoperative MRI tear locations were graded with the modified Sherman classification: type I (>90% distal remnant length), type II (75–90%), or type III (25–75%). MRI tissue quality was graded as good, fair, or poor. Arthroscopy videos were reviewed for tissue length and quality, and final treatment.
Sixty-three repair patients and 67 reconstruction patients were included. Repair patients had more often type I tears (41 vs. 4%, p < 0.001) and good tissue quality (89 vs. 12%, p < 0.001). Preoperative MRI tear location and tissue quality predicted eligibility for primary repair: 90% of all type I tears and 88% of type II tears with good tissue quality were repaired, while only 23% of type II tears with fair tissue quality, 0% of type II tears with poor tissue quality, and 14% of all type III tears could be repaired.
This study showed that tear location and tissue quality on preoperative MRI can predict eligibility for arthroscopic primary ACL repair. These findings may guide the orthopaedic surgeon on the preoperative assessment for arthroscopic primary repair of proximal ACL tears.
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Conflict of interest
Jelle P. van der List declares he has no conflict of interest. Gregory S. DiFelice is a paid consultant for Arthrex (Naples, FL).
No funding has been received for this study.
IRB approval obtained (Hospital for Special Surgery IRB number 16006).
Informed consent was obtained for all patients in the study.
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van der List, J.P., DiFelice, G.S. Preoperative magnetic resonance imaging predicts eligibility for arthroscopic primary anterior cruciate ligament repair. Knee Surg Sports Traumatol Arthrosc 26, 660–671 (2018) doi:10.1007/s00167-017-4646-z
- Primary anterior cruciate ligament repair
- Anterior cruciate ligament
- Magnetic resonance imaging
- Preoperative assessment
- ACL preservation