The Influence of Perioperative Nerve Block on Strength and Functional Return to Sports After Anterior Cruciate Ligament Reconstruction

Background: Patients often have quadriceps or hamstring weakness after anterior cruciate ligament reconstruction (ACLR), despite postoperative physical therapy regimens; however, little evidence exists connecting nerve blocks and ACLR outcomes. Purpose: To compare muscle strength at return to play in patients who received a nerve block with ACLR and determine whether a specific block type affected subjective knee function. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were recruited 5 to 7 months after primary, isolated ACLR and completed bilateral isokinetic strength tests of the knee extensor/flexor groups as a single-session return-to-sport test. Subjective outcomes were assessed with the International Knee Documentation Committee (IKDC) score. Strength was expressed as torque normalized to mass (N·m/kg) and limb symmetry index as involved/uninvolved torque. Chart review was used to determine the type of nerve block and graft used. Nerve block types were classified as knee extensor motor (femoral nerve), knee flexor motor (sciatic nerve), or isolated sensory (adductor canal block/saphenous nerve). A 1-way analysis of covariance controlling for graft type was used. Results: A total of 169 patients were included. Graft type distribution consisted of 102 (60.4%) ipsilateral bone–patellar tendon–bone (BTB) and 67 (39.6%) ipsilateral hamstring tendon. Nerve block type distribution consisted of 38 (22.5%) femoral, 25 (14.8%) saphenous, 45 (26.6%) femoral and sciatic, and 61 (36.1%) saphenous and sciatic. No significant difference was found in knee extensor strength ( P = .113) or symmetry ( P = .860) between patients with knee extensor motor blocks (1.57 ± 0.45 N·m/kg; 70.1% ± 15.3%) and those without (1.47 ± 0.47 N·m/kg; 69.6% ± 18.8%). A significant difference was found between patients with knee flexor motor blocks (0.83 ± 0.26 N·m/kg) and those without (0.92 ± 0.27 N·m/kg) for normalized knee flexor strength ( P = .21) but not knee flexor symmetry ( P = .592). Controlling for graft type, there were no differences in subjective knee function (IKDC score) between all nerve block groups ( P = .57). Conclusion: Our data showed that use of a sciatic nerve block with ACLR in patients with hamstring and BTB grafts influences persistent knee flexor strength deficits at time of return to sports. Although the cause of postoperative muscular weakness is multifactorial, this study adds to the growing body of evidence suggesting that perioperative nerve blocks affect muscle strength and functional rehabilitation after ACLR.

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Patients return to sports and to work after successful treatment of septic arthritis following anterior cruciate ligament reconstruction

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06819-x ◽

2021 ◽

Author(s):

Alexander Themessl ◽

Felix Mayr ◽

Kate Hatter ◽

Marco-Christopher Rupp ◽

Jonas Pogorzelski ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Septic Arthritis ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Return To Sports ◽

Cruciate Ligament Reconstruction ◽

Ikdc Score ◽

Anterior Cruciate

Abstract Purpose To determine specific return to sports (RTS) and return to work (RTW) rates of patients with septic arthritis following anterior cruciate ligament reconstruction (ACLR), and to assess for factors associated with a diminished postoperative return to physical activity after successful eradication of the infection. Methods In this study, patients who were treated for postoperative septic arthritis of the knee following anterior cruciate ligament reconstruction between 2006 and 2018 were evaluated at a minimum follow-up (FU) of 2 years. Patients’ outcomes were retrospectively analyzed using standardized patient-reported outcome scores including the Lysholm score and the subjective IKDC score, as well as return to sports and return to work questionnaires to assess for the types, number, and frequency of sports performed pre- and postoperatively and to evaluate for potential occupational changes due to septic arthritis following ACLR. To assess for the signifiance of the graft at follow-up, outcomes were compared between patients with a functioning graft at FU and those without, as well as between patients with initial graft retention and those with graft removal and consecutive revision ACLR. Results Out of 44 patients eligible for inclusion, 38 (86%) patients at a mean age of 36.2 ± 10.3 years were enrolled in this study. At a mean follow-up of 60.3 ± 39.9 months, the Lysholm score and the subjective IKDC score reached 80.0 ± 15.1 and 78.2 ± 16.6 points, respectively. The presence of a graft at FU yielded statistically superior results only on the IKDC score (p = 0.014). There were no statistically significant differences on the Lysholm score (n.s.) or on the IKDC score (n.s.) between patients with initial graft retention and those with initial removal who had undergone revision ACLR. All of the included 38 patients were able to return to sports at a median time of 8 (6–16) months after their last surgical intervention. Among patients who performed pivoting sports prior to their injury, 23 (62.2%) returned to at least one pivoting sport postoperatively. Overall, ten patients (26.3%) returned to all their previous sports at their previous frequency. The presence of a graft at FU resulted in a significantly higher RTS rate (p = 0.010). Comparing patients with initial graft retention and those with graft removal and consecutive revision ACLR, there was no statistically significant difference concerning the RTS rate (n.s.). Thirty-one patients (83.8%) were able to return to their previous work. Conclusion Successful eradication of septic arthritis following anterior cruciate ligament reconstruction allows for a postoperative return to sports and a return to work particularly among patients with ACL-sufficient knees. However, the patients’ expectations should be managed carefully, as overall return rates at the pre-injury frequency are relatively low. Level of evidence IV.

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Knee Extensor and Flexor Strength are Related to One-Leg Hop Distances in Three Directions in Patients Six Months After Anterior Cruciate Ligament Reconstruction

10.21203/rs.3.rs-112315/v1 ◽

2020 ◽

Author(s):

Junya Aizawa ◽

Kenji Hirohata ◽

Shunsuke Ohji ◽

Takehiro Ohmi ◽

Sho Mitomo ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Knee Extensor ◽

Knee Extension ◽

Return To Sports ◽

Cruciate Ligament Reconstruction ◽

Knee Strength ◽

Anterior Cruciate

Abstract Background: When planning rehabilitation and conditioning for performance enhancement and a return to sports after anterior cruciate ligament reconstruction, identifying the elements of physical function associated with one-leg hop is important. The purpose of this study was to clarify the relationship between one-leg hop distances in 3 directions and knee extensor and flexor strengths at 6 months after reconstruction.Methods: Participants were 47 patients taking part in training sessions for sports involving cutting, pivoting, and jump-landing 6 months after reconstruction using a hamstring tendon. Demographics, activity scale score, days before and after reconstruction, and meniscus surgery procedure were analyzed. One-leg hop distances in 3 directions (anterior, lateral, and medial) and isokinetic strengths of knee extension and flexion were measured. Simple regression analyses using Spearman's rank correlation coefficient were performed to assess relationships between one-leg hop distances and knee strengths.Results: In the involved limb, correlations between one-leg hop distance in 3 directions and knee strengths were significant and effect sizes ranged from medium to large. Correlation coefficients between all one-leg hop parameters and knee extension/flexion strengths at an angular velocity of 180°/s were greater than those of 60°/s.Conclusions: Knee strength showed moderate to high associations with lateral and medial one-leg hop distances in addition to anterior one-leg hop distance. The results of this study will be useful in planning and teaching conditioning to improve multi-directional one-legged hop skills and improve knee strength for a full-scale return to sports after reconstruction.

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Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118786454 ◽

2018 ◽

Vol 10 (6) ◽

pp. 515-522 ◽

Cited By ~ 2

Author(s):

William G. Blakeney ◽

Hervé Ouanezar ◽

Isabelle Rogowski ◽

Gregory Vigne ◽

Meven Le Guen ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Intraclass Correlation ◽

Control Group ◽

Diagnostic Study ◽

Return To Sports ◽

Sensitivity To Change ◽

Significant Difference ◽

Anterior Cruciate

Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.

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Comparative Study of the Reconstruction of Anterior Cruciate Ligament with Peroneal Longus Tendon and Hamstring Tendon Based on Magnetic Resonance Imaging

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.3017 ◽

2020 ◽

Vol 10 (6) ◽

pp. 1327-1332

Author(s):

Ming He ◽

Xu Sun ◽

Yonghui Fu

Keyword(s):

Treatment Group ◽

Magnetic Resonance ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Control Group ◽

Early Recovery ◽

Significant Difference ◽

Ikdc Score ◽

Anterior Cruciate ◽

Better Than

Objective: To compare the effect of reconstruction of anterior cruciate ligament (ACL) with peroneal longus tendon (PLT) and hamstring tendon (HT) using magnetic resonance image (MRI). Methods: Fifty-six patients with ACL rupture were treated with ACL reconstruction. Among them, 28 patients were treated with PLT reconstruction (treatment group) and 28 patients were treated with HT reconstruction (control group). There were no significant differences in gender, age, injury side, course of disease, preoperative Lachman test, Lysholm score, IKDC score, joint mobility, MRI image between the two groups (P > 0.05). Result: The incision healed in the first stage after operation in both groups, and there were no significant neurovascular injuries and knee synovitis complications. Comparing the MRI of the two groups after operation, the effect of the treatment group was better than that of the control group. There were no complications in both groups. The Lysholm score and IKDC score of the treatment group were better than those of the control group at 6 and 12 months after operation (P > 0.05). There was no significant difference in Lachman test between the two groups at 6 and 12 months after operation (P > 0.05). At 3 and 12 months after operation, the joint activity of the treatment group was better than that of the control group, with no significant difference (P > 0.05). The degree of tibial anterior displacement decreased significantly in both groups before and after operation (P < 0.05), but there was no significant difference between the two groups (P > 0.05). Discussion: MRI scanning technology can significantly expand the scope of human body examination, improve the detection rate and diagnostic accuracy of lesions. In traditional surgery, HT is often used as reconstruction material. However, there are many factors to be considered in the formulation of operation plan for double cruciate ligament injury, such as limb blood supply, accompanied by a variety of structural injuries, so the requirement for reconstruction is high. There was no significant difference in the recovery of knee stability between the two groups, but in terms of early recovery of knee function and subjective satisfaction of patients, the reconstruction of PLT was superior to that of HT. Conclusion: Magnetic resonance imaging can effectively diagnose the curative effect, and it is worth popularizing and applying widely. Compared with HT, ACL reconstruction with PLT is easier to operate, and the early recovery of knee joint function and it is worth popularizing and applying widely.

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The Functional Tests after ACL Reconstruction with and without Meniscal Repair

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2020726 ◽

2020 ◽

Author(s):

Sineenad Janewanitsataporn

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Rehabilitation Program ◽

Return To Sports ◽

Functional Tests ◽

Hop Tests ◽

Acl Rehabilitation ◽

Significant Difference ◽

Anterior Cruciate

Objective: This study aims to compare the functional tests after anterior cruciate ligament reconstruction (ACLR) with and without meniscal repair after the rehabilitation program and before returning to sports. Material and Methods: Patients who underwent ACLR using hamstring tendon autograft during 2016-2017 were invited to participate in this study and divided into 2 groups including with and without meniscal repairs according to the surgical reports. A group of ACLR with meniscal repair required the conservative anterior cruciate ligament (ACL) rehabilitation program because the non-weight-bearing approach should be applied during the first 6 weeks. These patients were followed up clinically until the rehabilitation program finished. The functional tests were applied with the 4 single-leg hop tests, as reported in the limb symmetry index (LSI). Results: Forty-three patients were enrolled in the program. These patients were divided into 2 groups: ACLR with meniscal repair (n=20) and ACLR without meniscal repair (n=23). It was found that there was no statistically significant difference between the two groups with respect to duration for completing the rehabilitation program (p-value=0.38). Also, there was no statistically significant difference between the two groups with respect to the LSI of all 4 singleleg hop tests of duration for completing the rehabilitation program. Conclusion: The conservative ACL rehabilitation program after meniscal repair surgery did not affect the function tests in terms of duration for completing the rehabilitation program before return to sports (RTS).

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COMPARISON OF CONTINUOUS ADDUCTOR CANAL AND FEMORAL NERVE BLOCKS FOR ANALGESIA AND SPORTS READINESS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN ADOLESCENT PATIENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00221 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0022

Author(s):

Erica L. Holland ◽

Robin Robbins ◽

Daniel K-W. Low ◽

Adrian Bosenberg ◽

Viviana Bompadre ◽

...

Keyword(s):

Cruciate Ligament ◽

Femoral Nerve ◽

Return To Sports ◽

Nerve Blocks ◽

Pain Scores ◽

Post Operative Pain ◽

Adolescent Patients ◽

Surgical Data ◽

Anterior Cruciate ◽

Quadriceps Function

Background: Continuous femoral nerve blocks (cFNB) have become a popular method for post-operative analgesia for patients undergoing anterior cruciate ligament reconstruction (ACLR). However, early weight-bearing and the return of quadriceps function favor a motor sparing block, such as a continuous adductor canal nerve block (cACB). Hypothesis/Purpose: We retrospectively compared cACB to cFNB in adolescent patients undergoing ACLR, assessing early post-operative pain scores, narcotic usage, and patient satisfaction; and return of quadriceps function and sports readiness at six months post-surgery. We hypothesized that cACB compared to cFNB would result in in a greater likelihood of sports readiness at six months without having compromised analgesia in the early post-operative period. Methods: We retrospectively reviewed a consecutive series of adolescent patients who underwent ACLR between January 2016 and September 2018 and received either a cACB or cFNB for post-operative pain management. Patient demographic and surgical data, post-operative pain scores, opioid consumption, satisfaction and complications, dates and results of the Return to Sports (RTS) evaluations were collected from the medical record. Comparisons of categorical and continuous variables between groups were made using the χ 2 test, Spearman correlation test, and one-way ANOVA with Bonferroni adjustment. Results: Ninety-one patients (53 with cFNB, 38 with cACB) were reviewed for post-operative analgesia outcomes and quadriceps function at six months and beyond. Analysis of demographic and surgical data revealed no difference in the make-up of the two groups. There were no significant differences between groups in the total oxycodone use PODs 1-3 ( p = 0.213), daily post-operative pain scores ( p > 0.25), or satisfaction with the blocks ( p = 0.93). There was no difference in time to RTS nor in the percentage of patients who achieved a 90% limb symmetry index for quadriceps strength when comparing the two groups at the six-month mark and beyond ( p = 0.384). Conclusions: We found no difference in post-operative analgesic requirements and high satisfaction in both groups when comparing patients who underwent ACLR with hamstring autograft with a cACB to those who underwent a similar procedure with a cFNB. Readiness for return to sports and return of quadriceps function at six months and beyond does not appear to vary with regional technique, either cACB or cFNB, employed at surgery.

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Manual Khalifa Therapy Improves Functional and Morphological Outcome of Patients with Anterior Cruciate Ligament Rupture in the Knee: A Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/462840 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Michael Ofner ◽

Andreas Kastner ◽

Engelbert Wallenboeck ◽

Robert Pehn ◽

Frank Schneider ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Common Knowledge ◽

Controlled Trial ◽

Cruciate Ligament ◽

International Knee Documentation Committee ◽

Specific Pressure ◽

Randomized Controlled ◽

Significant Difference ◽

Ikdc Score ◽

Anterior Cruciate

Rupture of the anterior cruciate ligament (ACL) is a high incidence injury usually treated surgically. According to common knowledge, it does not heal spontaneously, although some claim the opposite. Regeneration therapy by Khalifa was developed for injuries of the musculoskeletal system by using specific pressure to the skin. This randomized, controlled, observer-blinded, multicentre study was performed to validate this assumption. Thirty patients with complete ACL rupture, magnetic resonance imaging (MRI) verified, were included. Study examinations (e.g., international knee documentation committee (IKDC) score) were performed at inclusion (t0). Patients were randomized to receive either standardised physiotherapy (ST) or additionally 1 hour of Khalifa therapy at the first session (STK). Twenty-four hours later, study examinations were performed again (t1). Three months later control MRI and follow-up examinations were performed (t2). Initial status was comparable between both groups. There was a highly significant difference of mean IKDC score results att1andt2. After 3 months, 47% of the STK patients, but no ST patient, demonstrated an end-to-end homogeneous ACL in MRI. Clinical and physical examinations were significantly different int1andt2. ACL healing can be improved with manual therapy. Physical activity can be performed without pain and nearly normal range of motion after one treatment of specific pressure.

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Clinical Outcome Evaluation in Anterior Cruciate Ligament Reconstruction using Transportal Technique Augmented with Platelet Rich Plasma (PRP) Injection

The Hip and Knee Journal ◽

10.46355/hipknee.v1i1.21 ◽

2020 ◽

Vol 1 (1) ◽

pp. 19-27

Author(s):

Steesy Benedicta ◽

Mouli Edward ◽

Lukas Widhiyanto ◽

Dwikora Novembri Utomo ◽

Kukuh Dwiputra Hernugrahanto

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Platelet Rich Plasma ◽

Cruciate Ligament ◽

Outcome Evaluation ◽

Return To Sports ◽

Post Surgery ◽

Significant Difference ◽

Anterior Cruciate ◽

Transportal Technique

Background: Anterior cruciate ligament (ACL) injury is a common injury in the athlete with an incidence of 30-78 cases per year. PRP injection can be applied to enhance graft healing and help patient return to sports faster. Transportal placement is a newer technique and believed can handle this problem. No perspective surveillance system has been made to monitoring the outcome of ACL surgery using the transportal technique and PRP injection in our hospital.Materials and Methods: A total data of 157 patients using medical records in our hospital between 1 January 2014 and 31 December 2018 were evaluated. All patients underwent ACL reconstruction surgery using the transportal technique and additional platelet rich plasma (PRP) intraarticular, with the exclusion of multiple ligament and meniscal injuries. The values evaluated in this study were clinical examination, SF-12 Daily Living Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford knee Score (OKS), Tegner Lysholm score and Cincinnati score. Patients were followed up from a minimum of 6 months to 4 years after surgery.Results: We found male-dominant (82.8%) patients with the mean age is 25.59 ± 7.61 years old. MOI mostly sports-related activity (78,9%). Anterior drawer and Lachman test post-surgery showed significant improvement. SF-12 showed increasing post-op with mean 80.94. Mean Tegner Lysholm and Cincinnati post-operative was 87.30 and 378.57. OKS pre and post-op mean was 23.56 and 43.82. No significant difference in KOOS score with p0.0001.Conclusions: The ACL reconstruction augmentation with PRP injection with the transportal technique showed significant satisfaction and function restored to normal.

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Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI): a valid scale to quantify psychological readiness to return to sports after ankle ligament reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00010 ◽

2021 ◽

Vol 9 (2_suppl) ◽

pp. 2325967121S0001

Author(s):

Francois Sigonney ◽

Ronny Lopes ◽

Pierre Alban Bouché ◽

Alexandra Stein ◽

Alexandre Hardy

Keyword(s):

Ligament Reconstruction ◽

Cruciate Ligament ◽

Return To Sport ◽

Return To Sports ◽

Ankle Sprains ◽

Chronic Instability ◽

Ankle Ligament ◽

Significant Difference ◽

Anterior Cruciate ◽

Highly Correlated

Objectives: Chronic instability is the main complication of ankle sprains and requires surgical intervention if non-surgical treatment fails. The aim of this study was to validate a tool to quantify psychological readiness to return to sports after ankle ligament reconstruction. Methods: The form was designed like the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, and the term "anterior cruciate" was replaced by "ankle". The Ankle Ligament Reconstruction - Return to Sport after Injury Scale (ALR-RSI) was completed by patients who had undergone ankle ligament reconstruction and who practiced a sport. The scale was then validated according to the COSMIN international methodology. The AOFAS and Karlsson scores were used as reference questionnaires. Results: 57 patients (59 ankles) were included, 27 of whom were women. The ALR-RSI scale was highly correlated with the Karlsson score (r=0.79 [0.66-0.87]) and the AOFAS score (r=0.8 [0.66-0.87]). A highly significant difference was noted on the ALR-RSI scale between the subgroup of 50 patients who returned to sports and the 7 who did not: 68.8 (56.5-86.5) versus 45.0 (31.3-55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.92, 95% CI [0.86-0.96]). Conclusion: The ALR-RSI is a valid, reproducible scale with which to identify patients who are ready to resume the same sport after ankle ligament reconstruction. This scale can help to identify athletes who will have difficulty returning to sports.

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Repair versus reconstruction for proximal anterior cruciate ligament tears: a study protocol for a prospective multicenter randomized controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04280-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jelle P. van der List ◽

Harmen D. Vermeijden ◽

Inger N. Sierevelt ◽

Maarten V. Rademakers ◽

Mark L. M. Falke ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Acl Reconstruction ◽

Controlled Trial ◽

Cruciate Ligament ◽

Return To Sports ◽

Acl Repair ◽

Randomized Controlled ◽

Ikdc Score ◽

Anterior Cruciate

Abstract Background For active patients with a tear of the anterior cruciate ligament (ACL) who would like to return to active level of sports, the current surgical gold standard is reconstruction of the ACL. Recently, there has been renewed interest in repairing the ACL in selected patients with a proximally torn ligament. Repair of the ligament has (potential) advantages over reconstruction of the ligament such as decreased surgical morbidity, faster return of range of motion, and potentially decreased awareness of the knee. Studies comparing both treatments in a prospective randomized method are currently lacking. Methods This study is a multicenter prospective block randomized controlled trial. A total of 74 patients with acute proximal isolated ACL tears will be assigned in a 1:1 allocation ratio to either (I) ACL repair using cortical button fixation and additional suture augmentation or (II) ACL reconstruction using an all-inside autologous hamstring graft technique. The primary objective is to assess if ACL repair is non-inferior to ACL reconstruction regarding the subjective International Knee Documentation Committee (IKDC) score at two-years postoperatively. The secondary objectives are to assess if ACL repair is non-inferior with regards to (I) other patient-reported outcomes measures (i.e. Knee Injury and Osteoarthritis Outcome Score, Lysholm score, Forgotten Joint Score, patient satisfaction and pain), (II) objective outcome measures (i.e. failure of repair or graft defined as rerupture or symptomatic instability, reoperation, contralateral injury, and stability using the objective IKDC score and Rollimeter/KT-2000), (III) return to sports assessed by Tegner activity score and the ACL-Return to Sports Index at two-year follow-up, and (IV) long-term osteoarthritis at 10-year follow-up. Discussion Over the last decade there has been a resurgence of interest in repair of proximally torn ACLs. Several cohort studies have shown encouraging short-term and mid-term results using these techniques, but prospective randomized studies are lacking. Therefore, this randomized controlled trial has been designed to assess whether ACL repair is at least equivalent to the current gold standard of ACL reconstruction in both subjective and objective outcome scores. Trial registration Registered at Netherlands Trial Register (NL9072) on 25th of November 2020.

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