5. Les résultats cliniques de la réparation du LCA ne sont pas inférieurs à ceux de la reconstruction : Analyse appariée de 75 patients du SANTI Study Group.

ACL reconstruction is the gold standard of surgical treatment for ACL tears. Recently, there has been a renewed interest in ACL repair, and early results are promising. The purpose of this study was to compare outcomes following ACL repair versus ACL reconstruction at a minimum follow-up of two years.

A retrospective analysis of prospectively collected data was undertaken. Patients who underwent ACL repair were matched 1:1 to those who underwent ACL reconstruction using a propensity score. All patients underwent a return to sports evaluation (isokinetic test, K-START and ACL-RSI) at 6 months post-operatively. At final face-to-face follow-up, physical examination findings (including side to side laxity difference & pivot shift) were recorded. At final overall follow-up return to sport, complications, re-operations and outcome measures, including Lysholm, Tegner, International Knee Documentation Committee (IKDC), ACL-RSI, Forgotten Joint Score-12 (FJS) were recorded.

82 patients with ACL repair were matched with 82 patients who underwent isolated ACL reconstruction. 7 matched pairs were lost to follow-up, leaving 75 patients in each group. At 6 months postoperatively, the ACL repair group had a lower mean hamstring muscle deficit (1.7% ± 12.8) compared to their counterparts (-10.0% ± 12.8) (p<0.0001). At a mean final follow-up of 30 ± 4.8 months, non-inferiority criteria were met for ACL repair with respect to both the IKDC subjective score (ACL repair, 86.8 points; ACL reconstruction, 86.7 points; p<0.0001) and side to side antero-posterior laxity (ACL repair 1.0 mm; ACL reconstruction, 0.6 mm; p<0.0001). Furthermore, the ACL repair group had better FJS (82.0 ± 15.1) compared to ACL reconstruction (74.2 ± 21.7) (p=0.017) and no significant differences were observed regarding the occurrence of ACL graft rupture (ACL repair, 5,3% ; ACL reconstruction, 0%; p=0.617).

The outcomes of ACL repair were non-inferior to ACL reconstruction with respect to IKDC subjective scores and anteroposterior laxity. ACL repair was associated with better forgotten joint score and superior hamstring strength, without increase in graft rupture rates. ACL repair can be considered a useful option in carefully selected patients.