We studied the efficacy of arthroscopic ACL repair for femoral avulsion of the ligament in ten patients (18 to 32 years of age). The tibial attachment and the midsub-stance of the ligaments were intact. We placed 2 mattress sutures with #2 fiberwire. The footprint of the ACL on the medial wall was decorticated and a guide drill was passed from inside-out followed by an endobutton reamer. The sutures were retrieved through the femoral tunnel using a small skin incision and tied over a button in full extension.

The rehabilitation included weightbearing with a hinged knee brace in extension, and CPM machine for the first month. The minimum follow-up was one year (mean 14 months). Lachman, Pivot shift, drawer tests, KT-1000 were documented. At 1 year all patients were stable. Sixty percent tested symmetric on KT-1000 and within 2 mm of the controlateral site. Forty percent had Lachman and anterior drawer within 1 grade and KT-1000 scores of > 4mm from the non-injured knee. None of the patients had a positive pivot shift. Our short-term data on arthroscopic ACL repair of a specific tear pattern are encouraging despite the negative outcome of open repair reported in the literature.

The efficacy of thermal modulation of collagen utilizing an electrothermal device to treat low to moderate demand patients with mid-substance anterior cruciate ligament tears was studied. Ten patients with partial ACL tear were treated with thermal modulation of the ligament. A chondral pick was utilized to create vascular inlet channels within the intercondylar notch. The mean follow up was 18 months (range of 12 to 36 months).

The patients ranged from 21 to 47 years of age. On the physical examination and KT-1000 testing eight patients had good to excellent clinical results, one patient an acute traumatic failure at 18 months and one a poor outcome. However the KT-1000 results deteriorated after one year.

There may be some benefit in treating moderate to low demand patients with this technology; however the long term results are unknown.

There have been very few studies evaluating the efficacy of thermal modulation of the ACL, and those studies have included patients who have previously undergone ACL reconstruction and have developed a loose graft. To our knowledge, this is the only study that evaluates primary ACL injuries, and utilizes vascular inlet channels to allow cellular population of the treated ACL.