Purpose: To compare the failure rates, complications and patient-reported outcome measures (PROMs) between arthroscopic anterior cruciate ligament (ACL) repair and reconstruction (ACLR) for acute ACL rupture.

Methods: A search was conducted on MEDLINE, ScienceDirect, Scopus and Cochrane Library. Clinical studies reporting failure rates, complications or PROMs between ACL repair and ACLR with a minimum of 2-year follow-up period were included. The complications evaluated were residual knee laxity, subsequent secondary meniscus injury, scar-related complications, other knee-related complications and hardware removal rates. The PROMs evaluated were the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner score, Lysholm score and ACL-Return to Sport after Injury (ACL-RSI) scale. Subgroup analyses were conducted to evaluate the influence of repair techniques and surgical timing.

Results: Fourteen studies were included, with 565 patients in the ACL repair group and 684 patients in the ACLR group. The meta-analysis demonstrated that ACL repair results in a significantly higher failure rate (p = 0.006) and greater residual knee laxity (p < 0.0001) compared to ACLR. No significant differences were found in subsequent secondary meniscus injury, scar-related complications, other knee-related complications and hardware removal rates. In terms of PROMs, ACL repair demonstrated higher IKDC and Lysholm scores, comparable KOOS and Tegner score, but a significantly lower ACL-RSI scores (p = 0.02) compared to ACLR. Subgroup analysis by surgical timing indicated that repairs performed with an interval of ≤3 weeks produce similar failure rates (p = 0.33) but exhibit greater residual laxity (p = 0.006) compared to ACLR, whereas those >3 weeks showed both significantly higher failure rates (p = 0.01) and greater residual laxity (p = 0.001).

Conclusion: Arthroscopic repair performed more than 3 weeks after the initial injury was associated with a higher failure rate and greater residual laxity compared to ACLR.

Level of evidence: Level III, meta-analysis.

Keywords: anterior cruciate ligament repair; complications; failure; patient‐reported outcome measures; reconstruction.

© 2025 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.

目的： 比较急性前交叉韧带（ACL）撕裂的关节镜下前交叉韧带修复与重建（ACLR）之间的失败率、并发症和患者报告结果量表（PROMs）。

方法： 在MEDLINE、ScienceDirect、Scopus和Cochrane Library上进行了搜索。纳入了至少2年随访期的临床研究，这些研究报道了ACL修复与ACLR之间的失败率、并发症或PROMs。评估的并发症包括残留膝关节松弛、继发半月板损伤、瘢痕相关并发症、其他膝关节并发症和硬件移除率。评估的PROMs包括国际膝关节文档委员会（IKDC）评分、膝盖受伤和骨关节炎结果评分（KOOS）、Tegner评分、Lysholm评分和ACL-伤后重返运动量表（ACL-RSI）。进行了亚组分析，以评估修复技术和手术时间的影响。

结果： 共纳入14项研究，其中ACL修复组有565名患者，ACLR组有684名患者。荟萃分析显示，与ACLR相比，ACL修复的失败率显著更高（p = 0.006）且残留膝关节松弛度更大（p

结论： 在受伤后3周以上进行关节镜下修复与ACLR相比，具有较高的失败率和较大的残留松弛度。

证据水平： III级，荟萃分析。

关键词： 前交叉韧带修复；并发症；失败；患者报告结果量表；重建。