Primary Repair of Tibial-Sided Avulsion of the Anterior Cruciate Ligament.

Lesions of the anterior cruciate ligament (ACL) are common; the current gold standard of treatment for such lesions is ACL reconstruction. Tibial-sided soft-tissue avulsion is a rare subtype of ACL injuries. Unlike femoral-sided ACL repair, surgery for acute tibial-sided ACL ruptures has been neither reported nor described. This technical note presents a method for primary anatomic ACL reinsertion for an acute distal soft-tissue avulsion-type ACL injury, using a transosseous pull-out repair technique. Our technique, as an alternative to reconstruction, has the potential to enhance healing due to marrow stimulation (tibial tunneling). It also preserves the native insertion site and proprioceptive function, which may, in turn, reduce the risk of post-traumatic osteoarthritis.