The application of primary repair for anterior cruciate ligament (ACL) injuries remains controversial, and evidence-based guidelines have not yet been established. Remarkable advancements in arthroscopic techniques and biological stimuli have been achieved in the past decades, which may change expectations regarding the potential of ACL healing and clinical outcomes for patients. In this study, a global expert consensus on the primary repair of proximal ACL injuries was established. A panel of 16 experts from the fields of sports medicine and arthroscopic surgery was invited to participate in the compilation of this consensus statement. This project followed the Delphi approach to the consensus process involving steering, rating, and peer review groups. Ultimately, 14 statements were retained: four achieved unanimous support, six achieved strong consensus, and four did not achieve consensus. The expert consensus statement established in this study focused on surgical indications, decision-making, surgical techniques, adjunctive methods, prognostic factors, and rehabilitation following ACL repair. The accepted recommendations in these areas will assist doctors and therapists in standardizing the management of related pathologies. The consensus statement clearly states that the tear site and tissue quality are important for ensuring successful ACL repair, while other factors should also be considered. ACL reconstruction remains the gold standard for ACL repair until long-term follow-up data demonstrates otherwise.

After reconstructing the anterior cruciate ligament (ACL), unsatisfactory bone tendon interface healing may often induce tunnel enlargement at the early healing stage. With good biological features and high formability, Magnesium-Zinc-Gadolinium (ZG21) wires are developed to bunch the tendon graft for matching the bone tunnel during transplantation. Microstructure, tensile strength, degradation, and cytotoxicity of ZG21 wire are evaluated. The rabbit model is used for assessing the biological effects of ZG21 wire by Micro-CT, histology, and mechanical test. The SEM/EDS, immunochemistry, and in vitro assessments are performed to investigate the underlying mechanism. Material tests demonstrate the high formability of ZG21 wire as surgical suture. Micro-CT shows ZG21 wire degradation accelerates tunnel bone formation, and histologically with earlier and more fibrocartilage regeneration at the healing interface. The mechanical test shows higher ultimate load in the ZG21 group. The SEM/EDS presents ZG21 wire degradation triggered calcium phosphate (Ca-P) deposition. IHC results demonstrate upregulation of Wnt3a, BMP2, and VEGF at the early phase and TGFβ3 and Type Ⅲ collagen at the late phase of healing. In vitro tests also confirmed the Ca-P in the metal extract could elevate the expression of Wnt3a, β catenin, ocn and opn to stimulate osteogenesis. Ex vivo tests of clinical samples indicated suturing with ZG21 wire did not weaken the ultimate loading of human tendon tissue. In conclusion, the ZG21 wire is feasible for tendon graft bunching. Its degradation products accelerated intra-tunnel endochondral ossification at the early healing stage and therefore enhanced bone-tendon interface healing in ACL reconstruction.