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SUMMARY
Suturing a ruptured ACL has been largely
supplanted by the ACL reconstruction. The
primary reason can be found in the outcomes of
the original procedure. A primary ACL repair
most likely failed and was unreliable. Torn ends
could not be approximated enough, resulting in
a gap that prevented a healing of the ligament.
In contrast, the MCL heals successfully because
the gap is filled with a blood clot which allows
surrounding cells to invade and produce a
functional fibrovascular scar. Such a bridging
mass is not observed in the ACL, likely because
of premature dissolution of blood clot by
enzymes in the synovial fluid. If the tissue does
not heal, the sutures of the primary repair
eventually fatigue and fail.
A scaffold can be used to stabilize a provisional
blood clot between the torn ACL ends for
several weeks. This stabilized clot has been
found to heal a torn ACL with similar
mechanical properties as anACL reconstruction
in animal models. Moreover, there are
favorable effects, which might decrease the
risk of posttraumatic osteoarthritis. However,
these promising findings derive frompreclinical
studies; clinical data are not yet available.
Nevertheless, the bridge-enhanced repair of the
ACL could be a viable option for patients with
ACL injuries in the future.
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