Anterior Cruciate Ligament Reinsertion-Tensioning in Chronic Proximal Injuries Sherman I is Successful to Restore Anterior Knee Stability Case Series: Breaking A Paradigm

In the last decade there has been a growing interest in repairing acute Anterior Cruciate Ligament (ACL) tears, especially those proximal injuries with good remnants. Traditionally, the treatment of choice for these injuries and those of the middle third has been to remove the remnant or sometimes preserve it and perform a reconstruction using a tendon graft from the patient or from a bone bank. The results reported in the literature with respect to recovering stability are good and range between 85% and 95%, but also in recent years a growing number of failures due to re-rupture have been reported in all ages, especially in the population of risk that are young people under 25 years involved in contact sports. Regarding ACL repair, when the results are analyzed in Sherman I injuries, they range between 80% and 85% of good results, however there are very little reported in the literature on “repair-tensioning” the remnant when a rupture has occurred that is considered chronic due to its evolution time. Materials and methods. A longitudinal descriptive study of a retrospective case series was carried out with 48 patients who underwent reinsertion-tensioning of the ACL in proximal Sherman I injuries whose initial injury had occurred after 3 months and with a clinical follow-up of up to 48 months with an average of 24 months. All underwent a subjective evaluation with the TEGNER and IKDC scales; and a subgroup of 31 patients, in addition to the above, underwent anterior displacement tests of the tibia measured with an arthrometer. Results. Of 88 patients operated for chronic proximal ACL injuries (more than 3 months of injury), in a period from February 2018 to January 2022, 37 patients did not meet the inclusion criteria and 3 could not be evaluated, leaving 48 who completed the follow-upevaluation. 95% obtained a rating between good and excellent according to the TEGNER scale and 89% according to IKDC. 31 (79% of the total patients) who underwent objective measurement with an arthrometer obtained a difference of less than 2 mm with respect to the healthy knee. Conclusion. ACL reinsertion-tensioning in chronic proximal injuries with good remnants is a viable alternative that produces good and excellent results to recover joint stability, similar to those reported when traditional reconstruction techniques are used.