Abstract
The purpose of this study was to document outcomes following the healing response
procedure for treatment of complete, proximal anterior cruciate ligament (ACL) tears
in a mature, active population. Healing response is an all-arthroscopic procedure
that preserves the native ACL and makes use of an arthroscopic awl with a 45-degree
angle to make holes in the femoral attachment of the ACL and in the body of the ACL.
Patients were included in this IRB-approved study if they were ≥40 years old, had
a complete proximal ACL tear, and who had healing response within 6 weeks of initial
injury. In this study 48 patients (35 females, 13 males) with an average age of 51
years (range: 41 to 68 years) underwent the healing response procedure. Of these four
female patients (8.9%) required subsequent ACL reconstruction. Mean time to ACL reconstruction
was 34.5 months (range, 14.3 to 61.2 months). Of the 44, 41 patients (93%) had minimum
of 2-year follow-up at an average of 7.6 years (range, 2.2 to 13.4 years). Average
preoperative Lysholm score was 54 (range, 10 to 82) and improved to an average of
90 postoperatively (p = 0.001). Median Tegner Activity Scale at follow-up was 5 (range, 2 to 9). Median
patient satisfaction was 10 (range, 4 to 10). Higher patient satisfaction was correlated
with increased Lysholm score at follow-up (rho = 0.39, p = 0.02). Tegner Activity Scale was associated with postoperative Lysholm score (rho = 0.35,
p = 0.04). This study demonstrates the effectiveness of the healing response procedure
to allow patients to return to high levels of recreational activity and to restore
knee function to normal levels. In a select group of mature patients with acute proximal
ACL tears, the healing response procedure is an effective treatment technique.
Keywords
anterior cruciate ligament - healing response - primary repair
