Primary anterior cruciate ligament repair with suture tape augmentation: indications, failure predictors, clinical outcomes, and evidence gaps

Background Primary anterior cruciate ligament (ACL) repair has re-emerged as a tissue-preserving option for selected proximal tears. Suture tape augmentation may protect the repaired ligament during early healing, but its clinical role remains uncertain because outcomes vary across patient groups and surgical techniques. Methods A narrative review of PubMed, Scopus, Google Scholar, and reference lists was conducted to identify relevant clinical, imaging, arthroscopic, and biomechanical studies published mainly from 2015 to May 2026. Results The strongest indications for repair are acute Sherman type I and selected type II proximal tears with an adequate, reducible remnant, good tissue quality, and preserved synovial coverage. Biomechanical evidence supports improved time-zero stability with suture tape augmentation. Clinical studies report satisfactory short- to midterm outcomes in selected adults, whereas younger patients, high-demand athletes, military populations, delayed presentations, and less favorable tear characteristics have higher failure rates. Bridge-enhanced ACL restoration represents a distinct scaffold-assisted preservation strategy and was considered separately. Conclusions Primary ACL repair with suture tape augmentation is a selective preservation strategy rather than a general substitute for reconstruction. Larger comparative studies using standardized indications, techniques, rehabilitation protocols, and failure definitions are needed to establish its long-term role.