- The injury: Anterior cruciate ligament (ACL) injuries frequently occur as the result of pivoting quickly, landing awkwardly, or stopping suddenly¹ and are common in sports such as football, soccer, basketball and volleyball. Common symptoms include pain, swelling, trouble moving the knee normally, and problems weight-bearing.

ACL tears are categorized using a scale ranging from grade 1 (mild) to grade 3 (fully torn); this rating, along with tear location and other factors, determines treatment options.

- Context:

• The ACL is the most commonly injured ligament in the knee, making up nearly half of all knee injuries.² Approximately 200,000 ACL tears occur in the U.S. each year.³
• ACL injuries are considered an epidemic among adolescent and young athletes. According to the National ACL Injury Coalition, ACL injuries among high school athletes have surged by nearly 26% over the past 15 years.⁴ Soccer, basketball and lacrosse are among the top sports for ACL injuries in girls, while football, lacrosse and soccer lead for boys. Additionally, a recent study published in the Orthopaedic Journal of Sports Medicine found that 2.4% of boys and 2.0% of girls 9-15 years old suffered from ACL injuries, highlighting a significant concern for the youth population.⁵

- Treatment Options:

• ACL Repair: Certain ACL tears (typically lower-grade tears closer to the bone) may be candidates for repair, a procedure in which the ACL is reattached to the bone.
• All-Inside ACL Reconstruction: ACL reconstruction is the traditionally accepted and most common treatment for ACL injuries.⁶ A graft harvested from a tendon in the patient’s leg, called an autograft, or a graft from a donor, called an allograft, replaces the torn ACL. After drilling tunnels into the bone, the surgeon positions the graft and secures it using screws, buttons, or suture. All-inside ACL reconstruction is a bone-preserving technique that is less invasive than alternative reconstruction techniques because smaller tunnels are drilled. There are several graft options, including quadriceps, hamstring, and patellar tendons.
• Supplemental Treatment Options: Surgeons may choose to augment ACL repair or reconstruction with treatments designed to improve surgical outcomes. This could include biologic augmentation, such as using platelet-rich plasma and other biologic components along with the allograft or autograft, and/or the InternalBrace™ technique.
  • The InternalBrace technique, also known as "suture tape augmentation," uses a high-strength tape suture to protect an ACL repair or reconstruction during the postoperative rehabilitation period, significantly reducing the rate of reinjury.^7,8 The tape acts as a seat belt, protecting the native ACL (in a repair) or graft (in a reconstruction) from stretching too far or retearing as the patient returns to sports and activities.

- Advantages:

• ACL Repair: Easier and faster recovery than reconstruction^1,9,10and preservation of native anatomy.¹¹
• All-Inside ACL Reconstruction: Less pain and suffering,^12-15better knee stability and range of motion,¹⁶ and a faster recovery than traditional (not all-inside) ACL reconstruction.¹⁷

- Patients: Arthrex ACL products are used in procedures for more than one million patients globally per year. Notable patients include NFL quarterbacks Tom Brady and Joe Burrow, and Division 1 women’s basketball player Audrey Biggs.

- More information: Visit ACLTear.com

The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

Repair: ACL TightRope® with InternalBrace™ Ligament Augmentation System

Reconstruction: ACL TightRope® II Attachable Button System (ABS)

Pediatric ACL Reconstruction: QuadLink™ all-epiphyseal

Reconstruction

Reconstruction

Reconstruction

Audrey's Story

Bryce's Story

Trevor's Story

For more patient stories, visit acltear.com/patient-stories.

Contact Us

 ^References

1. Mayo Clinic. ACL injury: symptoms & causes. Diseases & Conditions. Accessed January 3, 2025. https://www.mayoclinic.org/diseases-conditions/acl-injury/symptomscauses/syc-20350738   
2. Evans J, Mabrouk A, Nielson JL. Anterior Cruciate Ligament Knee Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 17, 2023. 
3. Musahl V, Karlsson J. Anterior cruciate ligament tear. N Engl J Med. 2019;380(24):23412348. doi:10.1056/NEJMcp1805931 
4. National ACL Injury Coalition. Keeping youth on the field and active for life. Project Play. Accessed January 16, 2025. https://projectplay.org/acl-injury-prevention/main   
5. Etzel CM, Meghani O, Owens BD, Kocher MS, Field AE. Predictors of anterior cruciate ligament tears in adolescents and young adults. Orthop J Sports Med. 2024;12(9):23259671241272699. doi:10.1177/23259671241272699
6. Lowenstein NA, Haber DB, Ostergaard PJ, Collins JE, Matzkin EG. All-inside anterior cruciate ligament reconstruction using quadrupled semitendinosus: comparable 2-year outcomes in male and female patients. Arthroscopy. 2021;37(10):3140-3148. doi:10.1016/j.arthro.2021.03.077
7. Daniel AV, Wijdicks CA, Smith PA. Reduced incidence of revision anterior cruciate ligament reconstruction with internal brace augmentation. Orthop J Sports Med. 2023;11(7):23259671231178026. doi:10.1177/23259671231178026
8. Daniel AV, Smith PA. Less subsequent revision anterior cruciate ligament reconstruction following primary bone-patellar tendon-bone anterior cruciate ligament reconstruction with suture tape augmentation - A retrospective comparative therapeutic trial with 5-year follow-up. Arthroscopy. 2024;40(9):2455-2464. doi:10.1016/j.arthro.2024.01.019
9. van der List JP, DiFelice GS. Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament. Knee. 2017;24(4):798-807. doi:10.1016/j.knee.2017.04.007
10. Vermeijden HD, van der List JP, O'Brien R, DiFelice GS. Return to sports following arthroscopic primary repair of the anterior cruciate ligament in the adult population. Knee. 2020;27(3):906-914. doi:10.1016/j.knee.2020.04.001
11. Vermeijden HD, van der List JP, O'Brien R, DiFelice GS. Patients forget about their operated knee more following arthroscopic primary repair of the anterior cruciate ligament than following reconstruction. Arthroscopy. 2020;36(3):797-804. doi:10.1016/j.arthro.2019.09.041
12. Benea H, d'Astorg H, Klouche S, Bauer T, Tomoaia G, Hardy P. Pain evaluation after allinside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study. Knee. 2014;21(1):102-106. doi:10.1016/j.knee.2013.09.006
13. Lubowitz JH, Schwartzberg R, Smith P. Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Arthroscopy. 2013;29(7):1195-1200. doi:10.1016/j.arthro.2013.04.009
14. Lopes R, Klouche S, Odri G, Grimaud O, Lanternier H, Hardy P. Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique. Knee. 2016;23(1):111115. doi:10.1016/j.knee.2015.09.010
15. Blackman AJ, Stuart MJ. All-inside anterior cruciate ligament reconstruction. J Knee Surg. 2014;27(5):347-352. doi:10.1055/s-0034-1381960
16. van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: a paradigm shift. Surgeon. 2017;15(3):161-168. doi:10.1016/j.surge.2016.09.00
17. Bodendorfer BM, Michaelson EM, Shu HT, et al. Suture augmented versus standard anterior cruciate ligament reconstruction: a matched comparative analysis. Arthroscopy. 2019;35(7):2114-2122. doi:10.1016/j.arthro.2019.01.054