Primary repair of proximal anterior cruciate ligament injury: a global expert consensus statement

Shurong Zhang; Tian Xia; Xuesong Dai; Gregory S. DiFelice; Lars Engebretsen; Alberto Gobbi; Christiaan H. Heusdens; Gordon M. MacKay; Bertrand Sonnery-cottet; Jelle P. van der List; Shu-Hang P. Yung; Jianquan Wang; Yinghui Hua

doi:10.1093/burnst/tkae079

Burns & Trauma ›› 2025, Vol. 13 ›› Issue (1) :tkae079 DOI: 10.1093/burnst/tkae079

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Primary repair of proximal anterior cruciate ligament injury: a global expert consensus statement

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¹ Department of Sports Medicine, Huashan Hospital, Fudan University , No 12, Wulumuqi Zhong Road, Shanghai, China

² Second Affiliated Hospital of Zhejiang University , No 88, Jiefang Road, Hangzhou, Zhejiang, China

³ Orthopaedic Trauma Service, Department of Orthopaedic Surgery , Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY 10021, United States

⁴ Department of Orthopedic Surgery, Oslo University Hospital , Oslo 3143244, Norway

⁵ O.A.S.I. Bioresearch Foundation Gobbi N.P.O , Via Amadeo GA 24, I-20133, Milan, Italy

⁶ Department of Orthopaedics, Antwerp University Hospital and ASTARC, University of Antwerp , Antwerp 2803138, Edegem, Belgium

⁷ Stirling University , Stirling 2636910, Scotland, United Kingdom

⁸ Centre orthopédique Santy, FIFA medical Center of excellence, hôpital Mermoz, groupe Ramsay , 24 Ave Paul Santy, F-69008 Lyon, France

⁹ Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center , Columbus, Ohio, United States

¹⁰ Sports Medicine Research Institute, The Ohio State University Wexner Medical Center , Columbus, Ohio, United States

¹¹ Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong 999077, China

¹² Department of Sports Medicine, Peking University Third Hospital , Beijing 100191, China

^*Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China. E-mail: patrickyung@cuhk.edu.hk

Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China. E-mail: wjqsportsmed@163.com

Department of Sports Medicine, Huashan Hospital, Fudan University, No 12, Wulumuqi Zhong Road, Shanghai 200040, China. E-mail: hua_cosm@aliyun.com

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Abstract

The application of primary repair for anterior cruciate ligament (ACL) injuries remains controversial, and evidence-based guidelines have not yet been established. Remarkable advancements in arthroscopic techniques and biological stimuli have been achieved in the past decades, which may change expectations regarding the potential of ACL healing and clinical outcomes for patients. In this study, a global expert consensus on the primary repair of proximal ACL injuries was established. A panel of 16 experts from the fields of sports medicine and arthroscopic surgery was invited to participate in the compilation of this consensus statement. This project followed the Delphi approach to the consensus process involving steering, rating, and peer review groups. Ultimately, 14 statements were retained: four achieved unanimous support, six achieved strong consensus, and four did not achieve consensus. The expert consensus statement established in this study focused on surgical indications, decision-making, surgical techniques, adjunctive methods, prognostic factors, and rehabilitation following ACL repair. The accepted recommendations in these areas will assist doctors and therapists in standardizing the management of related pathologies. The consensus statement clearly states that the tear site and tissue quality are important for ensuring successful ACL repair, while other factors should also be considered. ACL reconstruction remains the gold standard for ACL repair until long-term follow-up data demonstrates otherwise.

Keywords

Anterior cruciate ligament / Primary repair / Expert consensus

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Shurong Zhang, Tian Xia, Xuesong Dai, Gregory S. DiFelice, Lars Engebretsen, Alberto Gobbi, Christiaan H. Heusdens, Gordon M. MacKay, Bertrand Sonnery-cottet, Jelle P. van der List, Shu-Hang P. Yung, Jianquan Wang, Yinghui Hua. Primary repair of proximal anterior cruciate ligament injury: a global expert consensus statement. Burns & Trauma, 2025, 13 (1) : tkae079 DOI:10.1093/burnst/tkae079

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