Emerging trends and evidence-based approaches in the management of partial anterior cruciate ligament tears: A narrative review

Partial anterior cruciate ligament (ACL) tears account for 10–27% of isolated ACL injuries and present diagnostic and therapeutic challenges due to their variable presentation and risk of progression. This narrative review aimed to synthesize evidence-based approaches to managing partial ACL tears through emerging biologic therapies and selective reconstruction techniques. A partial ACL tear diagnosis requires clinical tests, including Lachman’s test, pivot-shift tests, and the KT-1000 arthrometer, as well as imaging. The gold standard diagnostic tool is arthroscopy. Non-operative management using dynamic braces and rehabilitation suits low-demand patients, yet carries a high risk of progression to full ACL tears in active individuals. Biologic therapies, including platelet-rich plasma and mesenchymal stem cells, demonstrate promising results in preclinical studies but inconsistent outcomes in human trials. Managing partial ACL tears with minimally invasive approaches featured innovative options, including the healing response technique and scaffold-assisted repairs, such as bridge-enhanced ACL restoration. Selective bundle reconstruction repairs the partial tears, preserves remnant fibers, and improves proprioception and functional outcomes compared to complete ACL reconstruction. The management of partial ACL tears warrants case-specific approaches based on injury and patient factors. Although biologic and selective reconstruction techniques are promising, additional evidence from high-quality studies is needed to validate these approaches, refine them, and develop standardized protocols to optimize knee function.