Anterior Cruciate Ligament Repair Shows Higher Failure Rate but Similar Functional Outcomes Compared With Reconstruction at 5 Years in Matched‐Pair Analysis

PURPOSE: To compare the 5-year outcomes of anterior cruciate ligament (ACL) repair versus ACL reconstruction in a matched cohort. METHODS: Patients who underwent primary ACL repair or reconstruction between 2017 and 2019 were retrospectively analyzed. All surgical procedures were performed by two senior surgeons using standardized techniques. Patients were propensity matched 1:1 for age, sex, body mass index, time from injury to surgery, activity level, and preoperative pivot shift. Complications, reoperations, and patient-reported outcome measures (PROMs) including International Knee Documentation Committee, Lysholm, Knee injury and Osteoarthritis Outcome Score, ACL-Return to Sport after Injury, and Forgotten Joint Score-12 were evaluated at a minimum of 5 years. RESULTS: Seventy-one matched pairs (142 patients) were included, mean follow-up was 6.3 ± 1.1 years [0.5-7.6] in the repair group and 6.4 ± 0.5 years [5.7-7.4] in the reconstruction group. The failure rate was significantly higher in the repair group (15.5%) compared with the reconstruction group (4.2%) (P = .032). Subgroup analysis showed that this difference was primarily observed in patients younger than 40 years (P = .037) and in those presenting with a preoperative pivot shift (P = .025), whereas no difference was found in patients older than 40 years (P = .99) and without preoperative pivot shift (P = .68). A significantly higher proportion of patients in the repair group achieved the Patient Acceptable Symptom State for Knee injury and Osteoarthritis Outcome Score symptoms compared with reconstruction patients (67.7% vs. 47.0%, P = .033). No significant differences in mean patient-reported outcome measures were found between groups at final follow-up. CONCLUSION: At midterm follow-up, ACL repair showed comparable functional outcomes but higher failure rates than reconstruction, particularly in younger or pivoting patients. LEVEL OF EVIDENCE: Level III, retrospective matched comparative study.