Durable mid-term survivorship after proximal ACL repair with suture augmentation in a middle-aged cohort: A risk factor analysis.

Abstract

Arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears with suture augmentation (SA) provides a ligament-preserving alternative to reconstruction. Evidence on mid-term durability and associated risk factors for revision remains limited. This study evaluated revision-free survival at a minimum follow-up of 72 months and identified risk factors for revision. A consecutive cohort undergoing arthroscopic proximal ACL repair with SA, performed by a single surgeon between 2017 and 2019, was analysed. Revision-free survival was determined using Kaplan-Meier analysis with 95% confidence interval (CI). Risk factors were evaluated using parametric or non-parametric tests; significance was set at <i>p</i> < 0.05. A minimum follow-up of 72 months (median 79, interquartile range [IQR] 75-97) was completed by 80 patients (23 males; mean age 42 ± 13 years). Revision surgery was required in 13 patients (16%) after a median of 38 months, including six re-ruptures and seven chronic instabilities. Revision-free survival was 94% at 1 year, 88% at 5 years and 83% at 7 years. Age, body mass index (BMI), sex, surgical timing, meniscal or ligamentous injury and physiotherapy duration showed no significant associations. Arthroscopic proximal ACL repair with SA demonstrated durable survivorship exceeding 80% at 7 years. While preoperative Tegner score showed an exploratory association with revision risk, no independent predictor of failure was confirmed. These findings support proximal ACL repair with SA as a ligament-preserving option for carefully selected patients, particularly in middle-aged individuals with moderate mechanical demand. Generalizability to younger, high-demand athletes requires further prospective evidence. Level III, retrospective cohort study.