ArticleJournal of experimental orthopaedics2026
Durable mid-term survivorship after proximal ACL repair with suture augmentation in a middle-aged cohort: A risk factor analysis.
Article in Journal of experimental orthopaedics, 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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Abstract
Purpose: Arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears with suture augmentation (SA) provides a ligament-preserving alternative to reconstruction. Evidence on mid-term durability and associated risk factors for revision remains limited. This study evaluated revision-free survival at a minimum follow-up of 72 months and identified risk factors for revision. Methods: A consecutive cohort undergoing arthroscopic proximal ACL repair with SA, performed by a single surgeon between 2017 and 2019, was analysed. Revision-free survival was determined using Kaplan-Meier analysis with 95% confidence interval (CI). Risk factors were evaluated using parametric or non-parametric tests; significance was set at Results: A minimum follow-up of 72 months (median 79, interquartile range [IQR] 75-97) was completed by 80 patients (23 males; mean age 42 ± 13 years). Revision surgery was required in 13 patients (16%) after a median of 38 months, including six re-ruptures and seven chronic instabilities. Revision-free survival was 94% at 1 year, 88% at 5 years and 83% at 7 years. Age, body mass index (BMI), sex, surgical timing, meniscal or ligamentous injury and physiotherapy duration showed no significant associations. Conclusion: Arthroscopic proximal ACL repair with SA demonstrated durable survivorship exceeding 80% at 7 years. While preoperative Tegner score showed an exploratory association with revision risk, no independent predictor of failure was confirmed. These findings support proximal ACL repair with SA as a ligament-preserving option for carefully selected patients, particularly in middle-aged individuals with moderate mechanical demand. Generalizability to younger, high-demand athletes requires further prospective evidence. Level of Evidence: Level III, retrospective cohort study.
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