SynthesisBMC musculoskeletal disorders2026
Arthroscopic primary repair of the anterior cruciate ligament with internal brace ligament augmentation: a viable alternative to reconstruction? A systematic literature review and analysis.
Synthesis in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
backgroundPrimary anterior cruciate ligament (ACL) repair has re-gained significant interest due to its inherent anatomic advantages: retaining the proprioceptive fibers of the ACL may prevent kinesiophobia, while the procedure avoids donor site morbidity. Should revision become necessary, conventional ACL reconstruction remains a viable option. Research regarding this technique has accelerated, with 60.4% of the relevant literature published within the last 8 years. AIM OF THE STUDY: The most frequently reported technique is arthroscopic primary repair with internal brace ligament augmentation (IBLA). The objective of this study was to conduct a systematic review and analysis of contemporary papers, define the failure rate of the procedure, assess secondary outcomes, and identify optimal candidates for the procedure. PATIENTS AND
methodsA systematic search of the PubMed, MEDLINE and Cochrane Library databases was conducted reported in adherence to PRISMA guidelines. The inclusion criteria encompassed English publications (Level of evidence I-IV) from the last 10 years presenting arthroscopic operations with a study population of at least 10 patients. Included studies were required to report failure rates, complication rates and patient-reported outcome measures (PROMs) or objective knee joint laxity assessments with a mean follow-up exceeding 12 months and retention rates exceeding 80%.
resultsTwenty-four studies, representing 866 patients, were included. The mean age at the surgery was 34.8 years, and 45.0% of the cohort was male. The mean interval from injury to surgery was 41.6 days, with a mean follow-up duration of 31.1 months. A total of 79 failures were identified, corresponding to a mean failure rate of 9.1% CI 95% [7.2;11.0] for all included patients, and 9.8% CI 95% [7.8;11.9] for followed patients (n = 804). The incidence rate of failure was 3.8% CI 95% [2.9;4.6].
conclusionPrimary ACL repair with IBLA appears to be a feasible option for a well-defined patient subset. The results from contemporary studies are promising, demonstrating acceptable complication rate and excellent PROMs at mid-term follow-up, however, generalizability remains limited, consistent with the current level II–IV evidence base.
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