述评：前交叉韧带初次修复回归——但低龄仍是危险因素：明确谁、何时、如何修复
简介
原发性前交叉韧带（ACL）修复术因手术技术进步、生物学认知加深及组织保留理念的复兴，重新成为ACL重建的有力替代方案。研究回顾了多项病例系列及非对照研究，发现对于急性近端撕裂的严格筛选患者，初次ACL修复可获得较高的重返运动率和可接受的短期移植物存活率。多数研究中，此类患者接受快速手术以阻止组织退变。关键发现：尽管结果令人鼓舞，但成功高度依赖于“谁（患者年龄…
英文摘要
Primary anterior cruciate ligament (ACL) repair has re-emerged as a compelling alternative to reconstruction, fueled by advances in surgical techniques, biologic understanding, and renewed interest in tissue preservation. Yet, despite encouraging modern outcomes, fundamental questions remain regarding patient selection, surgical timing, and adjunctive procedures. Several case series and noncomparative studies show high return-to-sport rates and acceptable short-term survivorship following primary ACL repair in carefully selected patients with acute proximal tears. In the majority of studies, patients with proximal ACL tears who are candidates for primary ACL repair are expeditiously treated surgically to mitigate tissue degeneration. Although these findings highlight the potential viability of repair in contemporary practice, they also underscore critical nuances including strict inclusion criteria, the influence of age and activity level on failure risk, and the confounding role of augmentative procedures that limit broad generalization. As enthusiasm for repair continues to grow, surgeons must balance innovation with caution, recognizing that success appears highly dependent on the "who, when, and how" of surgical decision-making. Ultimately, primary ACL repair may represent a valuable option for select patients, but defining its precise role within modern ACL treatment algorithms remains an evolving challenge.