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Saad Berreta R, Villarreal-Espinosa JB, Pallone L, Cotter E, Spaan J, Manivannan A, Jackson G, Rafael Garcia J, Ayala S, Verma NN, Cole BJ, Chahla J. Anterior Cruciate Ligament Repair Results in Similar Patient Reported Outcome Measures as Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospective Comparative Studies. Arthroscopy 2024:S0749-8063(24)00673-X. [PMID: 39276949 DOI: 10.1016/j.arthro.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 08/31/2024] [Accepted: 09/01/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE To investigate the patient-reported outcomes (PROs), knee stability, and complications in prospective comparative studies of patients undergoing augmented anterior cruciate ligament (ACL) repair compared to ACL reconstruction (ACLR). METHODS A literature search was performed according to the 2020 PRISMA guidelines. Human clinical studies of level I-II evidence comparing PROs, knee stability and complications following ACL repair and reconstruction were included, and a qualitative analysis was performed. Excluded studies included those lacking reporting outcomes, studies that performed open ACLR or repair, studies published prior to the year 2000 and studies with evidence levels III-IV. Study quality was assessed using the Cochrane Collaboration's risk of bias tool. RESULTS Seven level of evidence I-II studies were retained including 190 ACLR and 221 repairs (75 Bridge-Enhanced ACL Repair (BEAR), 49 Suture Augmentation (SA), and 97 Dynamic Intraligamentary Stabilization (DIS)). At final follow-up, re-rupture rates varied between 0-14% (BEAR) vs 0-6% (ACLR) and mean side-to-side differences measured using KT-1000 testing ranged from 1.6-1.9mm (BEAR) vs 1.7-3.14mm (ACLR). For DIS vs ACLR, mean anterior tibial translation values at final follow-up were 1.7mm (DIS) vs. 1.4mm (ACLR), and re-rupture rates ranged from 20.8%-29% (DIS) vs. 17%-27.2% (ACLR). For SA vs ACLR, the mean side to side difference ranged from 0.2-0.39mm (SA) vs 0.33-0.4mm (ALCR), while the re-rupture rates were 10% (SA) vs. 0% (ACLR). International Knee Documentation Committee (IKDC), Tegner, Lysholm and Knee Injury and Osteoarthritis Outcome (KOOS) scores across both cohorts exhibited statistically significant, and comparable improvement, from baseline to final follow-up ranging from 1 to 5 years. CONCLUSION Augmented ACL repair results in similar patient reported outcomes measures in comparison to ACL reconstruction. However, augmented ACL repair may be associated with higher rates of failure given re-rupture rates of up to 14%, 29% and 10% for BEAR, DIS and SA, respectively. LEVEL OF EVIDENCE II; Systematic review of level I-II studies.
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Affiliation(s)
| | | | - Lucas Pallone
- Department of Orthopaedics, Rush University Medical Center
| | - Eric Cotter
- Department of Orthopaedics, Rush University Medical Center
| | | | | | | | | | - Salvador Ayala
- Department of Orthopaedics, Rush University Medical Center
| | - Nikhil N Verma
- Department of Orthopaedics, Rush University Medical Center
| | - Brian J Cole
- Department of Orthopaedics, Rush University Medical Center
| | - Jorge Chahla
- Department of Orthopaedics, Rush University Medical Center.
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Milantoni V, Sritharan P, Abdel Khalik H, AlKatanani F, Juric M, de Sa D. What's in a Name? Defining 'Failure' in Anterior Cruciate Ligament Reconstruction Randomized Controlled Trials: A Systematic Review. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09924-9. [PMID: 39196503 DOI: 10.1007/s12178-024-09924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE OF REVIEW Graft failure, one of the most common outcomes in anterior cruciate ligament reconstruction randomized controlled trials, lacks a consensus definition. The purpose of this study was to systematically summarize current practice and parameters in defining anterior cruciate ligament reconstruction graft 'failure'. RECENT FINDINGS Forty studies (4466 participants) satisfied the inclusion criteria. Of these, 90% either defined failure formally or referenced the etiology of failure, the remaining 10% used the term failure without referencing the anterior cruciate ligament reconstruction graft. Among the included studies, there was a high level of inconsistency between the definitions of graft failure. The extracted data was categorized into broader groups, revealing abnormal knee laxity (80%) and graft re-rupture (37.5%) as the most common parameters incorporated in the definitions of graft failure in high-level randomized controlled trials. This review shows that anterior cruciate ligament reconstruction randomized controlled trials lack a consistent definition for graft failure. A universal definition is vital for clarity in medical practice and research, ideally incorporating both objective (e.g. graft re-rupture) and subjective (e.g. validated questionnaires) parameters. A composite outcome should be established which includes some of the common parameters highlighted in this review. In the future, this review can be used to assist orthopaedic surgeons to establish a formal definition of anterior cruciate ligament reconstruction graft 'failure'.
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Affiliation(s)
| | - Praveen Sritharan
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Fares AlKatanani
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Canada
| | - Matey Juric
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
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Vendrig T, Keizer MN, Brouwer RW, Hoogeslag RA. Incidence of Osteoarthritis Between ACL Reconstruction With Different Graft Types and Between ACL Reconstruction and Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med 2024; 12:23259671241258775. [PMID: 39157020 PMCID: PMC11328256 DOI: 10.1177/23259671241258775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/01/2024] [Indexed: 08/20/2024] Open
Abstract
Background Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development. Purpose To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR. Study Design Systematic review; Level of evidence, 1. Methods A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR. Results Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft. Conclusion This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.
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Affiliation(s)
- Tom Vendrig
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michèle N.J. Keizer
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reinoud W. Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, Groningen, the Netherlands
| | - Roy A.G. Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, the Netherlands
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Rilk S, Goodhart GC, van der List JP, Von Rehlingen-Prinz F, Vermeijden HD, O'Brien R, DiFelice GS. Anterior cruciate ligament primary repair revision rates are increased in skeletally mature patients under the age of 21 compared to reconstruction, while adults (>21 years) show no significant difference: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38967267 DOI: 10.1002/ksa.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE To evaluate the impact of age as a risk factor on the revision rates of anterior cruciate ligament (ACL) primary repair (ACLPR), dynamic intraligamentary stabilization (DIS) and bridge-enhanced ACL restoration (BEAR) compared to ACL reconstruction (ACLR). METHODS A systematic literature search was performed for comparative studies comparing outcomes for ACLPR, DIS or BEAR to ACLR. A random-effects meta-analysis was performed to assess nondifferentiated and age-differentiated (skeletally mature patients ≤21 and >21 years) ACL revision and reoperation risk, as well as results for subjective outcomes. Methodological study quality was assessed using the Risk of Bias Tool 2.0c and Methodological Index for Nonrandomized Studies tools. RESULTS A total of 12 studies (n = 1277) were included. ACLR demonstrated a lower nonage-stratified revision risk at 2 years versus ACLPR, DIS and BEAR, but a similar revision risk at 5 years when compared to DIS. However, an age-stratified analysis demonstrated a significantly increased ACLPR revision risk as compared to ACLR in skeletally mature patients ≤21 years of age (risk ratios [RR], 6.33; 95% confidence interval [CI], 1.18-33.87, p = 0.03), while adults (>21 years) showed no significant difference between groups (RR, 1.48; 95% CI, 0.25-8.91, n.s.). Furthermore, DIS reoperation rates were significantly higher than respective ACLR rates (RR, 2.22; 95% CI, 1.35-3.65, p = 0.002), whereas BEAR (RR, 1.07; 95% CI, 0.41-2.75, n.s.) and ACLPR (RR, 0.81; 95% CI, 0.21-3.09, n.s.) showed no differences. IKDC scores were equivalent for all techniques. However, ACLPR exhibited significantly better FJS (mean difference, 11.93; 95% CI, 6.36-17.51, p < 0.0001) and Knee injury and Osteoarthritis Outcome Score Symptoms (mean difference, 3.01; 95% CI, 0.42-5.60, p = 0.02), along with a lower Tegner activity reduction. CONCLUSIONS ACLPR in skeletally mature patients ≤21 years of age is associated with up to a six-fold risk increase for ACL revision surgery compared to ACLR; however, adults (>21 years) present no significant difference. Based on the current data, age emerges as a crucial risk factor and should be considered when deciding on the appropriate treatment option in proximal ACL tears. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sebastian Rilk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
- Medical University of Vienna, Vienna, Austria
| | - Gabriel C Goodhart
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Fidelius Von Rehlingen-Prinz
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert O'Brien
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA
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Muench LN. Editorial Commentary: Noninferiority of Anterior Cruciate Ligament Repair With Dynamic Intraligamentary Stabilization at Short- to Mid-Term Follow-Up Does Not Justify Superseding Anterior Cruciate Ligament Reconstruction as the "Gold Standard" for Anterior Cruciate Ligament Surgery. Arthroscopy 2024; 40:2132-2134. [PMID: 38458549 DOI: 10.1016/j.arthro.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
With advances in surgical technology, including the introduction of some kind of mechanical augmentation, there has been a resurgence of interest in primary repair of the anterior cruciate ligament (ACL). If successful, ACL repairs may provide several advantages over reconstruction resulting from the preservation of the native anatomy and proprioception. Recently, augmentation of ACL repair using dynamic intraligamentary stabilization (DIS) has been proposed, to create an optimal biomechanical environment for healing. In the DIS technique, an additional nonresorbable cord is placed along the ACL and attached to a dynamic spring fixed in the proximal tibia, keeping the tibia in a posterior drawer position at every degree of flexion. The analyzed randomized controlled trials comparing ACL repair with DIS to ACL reconstruction found overall similar failure and revision rates, whereas the few observed statistically significant differences in functional scores or knee stability favoring either of the techniques were clearly not clinically relevant. Of course, repair of a torn ACL should be limited to a specific subset of patients presenting with an acute femoral avulsion tear with minimal retraction and good tissue quality. However, the present short- to mid-term results do not justify ACL reconstruction to be superseded by ACL repair with DIS as the "gold standard" for surgical treatment of ACL tears in the future, even in this subset of patients.
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Sherman SL, Raji Y, Calcei JG, Sherman MF. Anterior Cruciate Ligament Repair-Here to Stay or History Repeating Itself? Clin Sports Med 2024; 43:433-448. [PMID: 38811120 DOI: 10.1016/j.csm.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.
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Affiliation(s)
- Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA.
| | - Yazdan Raji
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA
| | - Jacob G Calcei
- University Hospitals Drusinsky Sports Medicine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Hanna House 6th Floor, Cleveland, OH 44106, USA
| | - Mark F Sherman
- Richmond University Medical Center, 2052 Richmond Road, Staten Island, NY 10306, USA
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7
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Ambrosio L, Franco D, Vadalà G, Russo F, Papalia R. Anterior Cruciate Ligament Repair Augmented With Dynamic Intraligamentary Stabilization Is Equivalent to Hamstring Autograft Reconstruction at Short- and Mid-Term Follow-Up: A Systematic Review. Arthroscopy 2024; 40:2121-2131.e1. [PMID: 38417640 DOI: 10.1016/j.arthro.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 03/01/2024]
Abstract
PURPOSE To compare clinical outcomes, knee stability and complications, failure, and revision rates after anterior cruciate ligament repair (ACLr) with dynamic intraligamentary stabilization (DIS) versus anterior cruciate ligament reconstruction (ACLR) with hamstring autograft for primary ACL ruptures at short and mid-term follow-up. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of PubMed/MEDLINE and Scopus was performed. Studies that evaluated patients undergoing ACLr with DIS or ACLR with hamstring autograft were considered for inclusion. Studies were excluded if patients were affected by concomitant meniscal, ligamentous, or chondral injuries needing surgical treatment, because of their potential confounding effect on postoperative outcomes. The Risk of Bias-2 tool was used to assess the risk of bias in the included studies. The quality of available evidence was rated according to Grading of Recommendations Assessment, Development, and Evaluation recommendations. The study protocol was registered in the PROSPERO database (ID: CRD42023394558). RESULTS Five randomized controlled trials comparing the outcomes of ACLr with DIS versus ACLR with hamstring autograft met the inclusion criteria. No major differences in terms of patient-reported outcomes (International Knee Documentation Committee subjective form, Lysholm score, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score, visual analog scale satisfaction) or rates of complications, revisions, and failures were found in included studies at all time points. Repair showed greater International Knee Documentation Committee subjective form scores at 5 years in one study, whereas ACLR displayed significantly increased knee stability at 6 months and 5 years in 2 different studies, although the clinical relevance of these differences is doubtful. CONCLUSIONS The results of this study suggest that ACLr with DIS is not inferior to ACLR with hamstring autograft in terms of rates of clinical outcomes, knee stability, risk of failure, complications, and revision surgery. Therefore, ACLr with DIS may be a viable alternative to ACLR with hamstring autograft in selected patients. LEVEL OF EVIDENCE Level I, systematic review of Level I studies.
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Affiliation(s)
- Luca Ambrosio
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Domenico Franco
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Fabrizio Russo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Opoku M, Fang M, Lu W, Li Y, Xiao W. Acute anterior cruciate ligament rupture: can repair become an alternative to reconstruction: a meta-analysis of randomized controlled trials and cohort studies. J Orthop Surg Res 2024; 19:331. [PMID: 38825707 PMCID: PMC11145936 DOI: 10.1186/s13018-024-04812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 06/04/2024] Open
Abstract
PURPOSE To perform a meta-analysis to compare clinical outcomes of anterior cruciate ligament (ACL) repair and ACL reconstruction for acute ACL rupture. METHOD We searched Pubmed, Embase, the Cochrane Library, and Web of Science databases to seek relevant studies. Clinical outcomes included failure rate, hardware removal rate, anteroposterior (AP) knee laxity, and patient-reported outcomes. In addition, subgroup analysis was carried out according to repair techniques, rupture locations, and study designs. Funnel plots were used to detect publication bias. All statistical analysis was performed using STATA (version 14.2, StataCorp). RESULTS A total of 10 articles were included in this study, comprising 5 randomized controlled trials (RCTs) and 5 cohort studies, involving a total of 549 patients. We found no statistical differences between the ACL repair and ACL reconstruction in the following outcomes: failure rate, AP knee laxity, International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome (KOOS) Score, and Tegner score. However, the ACL repair group had a higher hardware removal rate. Except for AP knee laxity results on different repair techniques, there was no statistical difference in other subgroup analyses. CONCLUSION Compared with ACL reconstruction, ACL repair shows similar results in clinical outcomes, and it is promising to be an effective alternative treatment for acute ACL rupture. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of ACL repair in other aspects. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael Opoku
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Mingqing Fang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, 410083, China
| | - Wenhao Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Wenfeng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
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Kunze KN, Pareek A, Nwachukwu BU, Ranawat AS, Pearle AD, Kelly BT, Allen AA, Williams RJ. Clinical Results of Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament: A Systematic Review and Meta-analysis of Contemporary Trials. Orthop J Sports Med 2024; 12:23259671241253591. [PMID: 38867918 PMCID: PMC11168252 DOI: 10.1177/23259671241253591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 06/14/2024] Open
Abstract
Background Primary anterior cruciate ligament (ACL) repair has gained renewed interest in select centers for patients with proximal or midsubstance ACL tears. Therefore, it is important to reassess contemporary clinical outcomes of ACL repair to determine whether a clinical benefit exists over the gold standard of ACL reconstruction (ACLR). Purpose To (1) perform a meta-analysis of comparative trials to determine whether differences in clinical outcomes and adverse events exist between ACL repair versus ACLR and (2) synthesize the midterm outcomes of available trials. Study Design Systematic review; Level of evidence, 3. Methods The PubMed, OVID/Medline, and Cochrane databases were queried in August 2023 for prospective and retrospective clinical trials comparing ACL repair and ACLR. Data pertaining to tear location, surgical technique, adverse events, and clinical outcome measures were recorded. DerSimonian-Laird random-effects models were constructed to quantitatively evaluate the association between ACL repair/ACLR, adverse events, and clinical outcomes. A subanalysis of minimum 5-year outcomes was performed. Results Twelve studies (893 patients; 464 ACLR and 429 ACL repair) were included. Random-effects models demonstrated a higher relative risk (RR) of recurrent instability/clinical failure (RR = 1.64; 95% confidence interval [CI], 1.04-2.57; P = .032), revision ACLR (RR = 1.63; 95% CI, 1.03-2.59; P = .039), and hardware removal (RR = 4.94; 95% CI, 2.10-11.61; P = .0003) in patients who underwent primary ACL repair versus ACLR. The RR of reoperations and complications (knee-related) were not significantly different between groups. No significant differences were observed when comparing patient-reported outcome scores. In studies with minimum 5-year outcomes, no significant differences in adverse events or Lysholm scores were observed. Conclusion In contemporary comparative trials of ACL repair versus ACLR, the RR of clinical failure, revision surgery due to ACL rerupture, and hardware removal was greater for primary ACL repair compared with ACLR. There were no observed differences in patient-reported outcome scores, reoperations, or knee-related complications between approaches. In the limited literature reporting on minimum 5-year outcomes, significant differences in adverse events or the International Knee Documentation Committee score were not observed.
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Affiliation(s)
- Kyle N. Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U. Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Anil S. Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D. Pearle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T. Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Answorth A. Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Riley J. Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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10
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Schneider KN, Theil C, Gosheger G, Weller JF, Goth A, Ahlbaeumer G. Rate of Revision Surgery and Associated Risk Factors After Primary Arthroscopic ACL Repair With Additional Suture Augmentation. Orthop J Sports Med 2024; 12:23259671241244734. [PMID: 38827140 PMCID: PMC11143819 DOI: 10.1177/23259671241244734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background Recent studies have suggested promising patient-reported outcomes after primary anterior cruciate ligament (ACL) repair with additional suture augmentation (SA). Purpose To evaluate the risk for revision surgery and identify patient- and injury-related risk factors after ACL repair with SA in a large patient cohort subject to strict patient selection. Study Design Case-control study; Level of evidence, 3. Methods Included were 86 patients (61 female; 93% follow-up rate) who underwent arthroscopic ACL repair with SA between January 2017 and March 2019 by a single surgeon and had a minimum follow-up of 24 months. Patients were selected for surgery with regard to time to surgery (preferably on the day of injury), tear pattern (limited to Sherman types 1 and 2), and tissue quality (intact synovial coverage). Postoperatively, the patients who needed revision surgery were identified and compared with patients who did not undergo revision surgery, using the Mann-Whitney U test for nonparametric analysis and the Student t test for parametric analysis. A Kaplan-Meier analysis was performed to investigate the survival rate of the ACL repair. Results A total of 9 patients (10%; median age, 48 years; interquartile range [IQR], 27-50 years) underwent revision surgery at 12 months postoperatively (IQR, 8-25 months). The median follow-up of patients without revision surgery was 35 months (IQR, 33-44 months). The revision-free survival rate was 97% (95% CI, 93%-100%) after 1 year, 93% (95% CI, 88%-98%) after 2 years, and 90% (95% CI, 83%-97%) after 4 years. Patient-related factors-such as sex (P = .98), age at surgery (P = .459), body mass index (P = .352), and preinjury level of sports (P = .53)-had no significant impact on the survival rate of the ACL repair. Injury-related factors-such as concomitant injuries of the medial (P = .860) and lateral menisci (P = .414) and the medial (P = .801) and lateral collateral ligaments (P = .534) or same-day surgery compared with a delay of surgery of up to 18 days (P = .277)-had no significant impact on the survival rate of the ACL repair. Conclusion The revision rate of primary ACL repair with SA at a 2-year follow-up was 10%. Patient- and injury-related factors were not associated with the survival rate of the ACL repair.
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Affiliation(s)
- Kristian Nikolaus Schneider
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Jan Frederic Weller
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
| | - Anna Goth
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
- Department of Trauma Surgery, BG Trauma Clinic Frankfurt, Frankfurt, Germany
| | - Georg Ahlbaeumer
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
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11
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Yuan W, Qi W, Hu T, Zhang J, An MY, Zhao G, Wang XP, Li C, Liu Y. Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction. Orthop Surg 2024; 16:337-345. [PMID: 38088239 PMCID: PMC10834228 DOI: 10.1111/os.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES There is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction. METHODS This retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A (n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B (n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side-to-side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi-square test and the continuous variables conforming to a normal distribution were analyzed by Student's t-test. RESULTS At 2 years postoperation, the VAS score (1.61 ± 0.55), side-to-side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side-to-side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side-to-side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups. CONCLUSION RigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5-year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels.
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Affiliation(s)
- Wei Yuan
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Wei Qi
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tingting Hu
- The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jia Zhang
- Medical School of Chinese PLA, Beijing, China
| | | | - Gang Zhao
- Medical School of Chinese PLA, Beijing, China
| | - Xiao-Ping Wang
- Department of Orthopedics, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Chunbao Li
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yujie Liu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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12
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Ren Y, Wang J, Ji J, Zhang C, Meng Q. Comparison of Clinical Outcomes Between Modern Augmented ACL Repair and Autograft ACL Reconstruction: A Systematic Review and Meta-analysis of Studies With Minimum 2-Year Follow-up. Orthop J Sports Med 2024; 12:23259671231223743. [PMID: 38282789 PMCID: PMC10812109 DOI: 10.1177/23259671231223743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 01/30/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction has been the gold standard for primary ACL rupture since the 1990s. In the past decade, ACL repair has received renewed attention and increased research. Purpose To compare the clinical outcomes of modern augmented ACL repair versus autograft reconstruction for ACL ruptures. Study Design Systematic review; Level of evidence, 3. Methods A search of the PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases was conducted for prospective or retrospective comparative studies published between January 1, 2010, and January 3, 2023, with a minimum 2-year follow-up. Two independent reviewers performed data extraction and methodological quality assessment. Sensitivity analysis was performed to maintain the stability of results. Results Nine studies were included (minimum follow-up period, 24-60 months). The total sample size was 833 patients (augmented repair group: 358 patients; autograft ACL reconstruction group: 475 patients). There were 4 randomized controlled trials (level 1), 1 prospective comparative study (level 2), 2 retrospective comparative studies (level 3), and 2 case-control studies (level 3). The augmented ACL repair group attained significantly higher Lysholm score (weighted mean difference [WMD] = 1.57; 95% confidence interval [CI], 0.14-3.01; P = .03) and hamstring strength (WMD = 36.69; 95% CI, 29.07-44.31; P < .01) but had higher rates of hardware removal (odds ratio [OR] = 6.30; 95% CI, 2.44-16.23; P = .0001), reoperation (OR = 1.87; 95% CI, 1.33-2.62; P = .0003), and failure (OR = 1.58; 95% CI, 1.03-2.43; P = .0003) compared with the autograft ACL reconstruction group. No significant differences were observed between the repair and reconstruction groups regarding postoperative International Knee Documentation Committee scores, Tegner scores, knee laxity, satisfaction, ACL revisions, complications, and reoperation rather than revision. Conclusion Augmented ACL repair was associated with higher rates of reoperation, hardware removal, and failure compared with autograft ACL reconstruction in studies with minimum 2-year follow-up data. However, augmented ACL repair had higher Lysholm scores and hamstring strength versus autograft ACL reconstruction.
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Affiliation(s)
- Yunong Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Jia Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Junjie Ji
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chao Zhang
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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13
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Robinson JD, Williamson T, Carson T, Whelan RJ, Abelow SP, Gilmer BB. Primary anterior cruciate ligament repair: Current concepts. J ISAKOS 2023; 8:456-466. [PMID: 37633336 DOI: 10.1016/j.jisako.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
The renewed interest in ACL repair over the last two decades stems from advances in modern arthroscopic techniques and clinical studies that have provided evidence that the ACL can reliably heal, and patients can return to sport at a comparable rate to ACL reconstruction patients. The ability to maintain and utilize native ACL tissue, with proprioceptive capabilities, and the smaller drill tunnels needed to repair an ACL leads to an overall less invasive procedure and improved early rehabilitation. Additionally, repair avoids a variety of comorbidities associated with autograft harvest. This current concept review details modern techniques of ACL repair and their current studies, a review on the use of biologic enhancement in ACL repair, and other considerations to appropriately integrate ACL repair into the sports medicine orthopaedic surgeon's practice.
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Affiliation(s)
- John D Robinson
- Lake Tahoe Sports Medicine Fellowship, Barton Center for Orthopedics and Wellness, 2170B South Ave., South Lake Tahoe, CA 96150, USA. Correspondence:
| | - Tyler Williamson
- Lake Tahoe Sports Medicine Fellowship, Barton Center for Orthopedics and Wellness, 2170B South Ave., South Lake Tahoe, CA 96150, USA
| | - Taylor Carson
- University of Nevada, Reno School of Medicine, 1664 N Virginia St., Reno, NV 89557, USA
| | - Ryan J Whelan
- University of Nevada, Reno School of Medicine, 1664 N Virginia St., Reno, NV 89557, USA
| | - Stephen P Abelow
- Lake Tahoe Sports Medicine Fellowship, Barton Center for Orthopedics and Wellness, 2170B South Ave., South Lake Tahoe, CA 96150, USA
| | - Brian B Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, 85 Sierra Park Rd. Mammoth Lakes, CA 93546, USA
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14
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Bühl L, Müller S, Nüesch C, Pagenstert G, Mündermann A, Egloff C. Functional leg performance 2 years after ACL surgery: a comparison between InternalBrace™-augmented repair versus reconstruction versus healthy controls. J Orthop Traumatol 2023; 24:52. [PMID: 37735271 PMCID: PMC10513977 DOI: 10.1186/s10195-023-00723-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND While clinical and patient-reported outcomes have been investigated in patients after InternalBrace™-augmented anterior cruciate ligament repair (ACL-IB), less is known regarding restoration of functional performance. We aimed to determine differences in functional performance within and between patients 2 years after ACL-IB, patients 2 years after ACL reconstruction (ACL-R), and healthy controls. MATERIALS AND METHODS A total of 29 ACL-IB, 27 ACL-R (hamstring autograft), and 29 controls performed single-leg hop (maximum forward distance hop, SLH; side hop > 40 cm in 30 s, SH), proprioception (knee joint position sense at 30° and 60° flexion), and dynamic postural balance (Y Balance) tests. Differences were calculated within groups (side-to-side difference) and between the involved leg of patients and the non-dominant leg of controls, and were evaluated to predefined statistical (P < 0.05), clinically relevant, and methodological (smallest detectable change) thresholds. The number of exceeded thresholds represented no (0), small (1), moderate (2), or strong (3) differences. In addition, the relative number of participants achieving leg symmetry (≥ 90%) and normal performance (≥ 90% of the average performance of the non-dominant leg of controls) were compared between groups (chi-squared tests, P < 0.05). RESULTS We observed no-to-moderate leg differences within ACL-IB (moderate difference in hops) and within ACL-R (moderate difference in knee proprioception), no leg differences between patient groups, no-to-small leg differences between ACL-IB and controls, and no leg differences between ACL-R and controls in functional performance. However, two patients in ACL-IB and ACL-R, respectively, passed the hop pretest only with their uninvolved leg, and fewer patients after ACL-IB and ACL-R than controls reached a leg symmetry and normal leg performance of controls in SLH (P < 0.001). CONCLUSIONS Functional performance seems to be comparable 2 years postoperatively between ACL-IB and ACL-R for a specific subgroup of patients (i.e., proximal ACL tears, moderate activity level). However, the presumed advantage of comparable functional outcome with preserved knee structures after augmented ACL repair compared with ACL-R, and the tendency of both patient groups toward leg asymmetry and compromised single-leg hop performance in the involved legs, warrants further investigation. Level of Evidence Level III, case-control study. Trial registration clinicaltrials.gov, NCT04429165 (12/09/2020). Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT04429165 .
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Affiliation(s)
- Linda Bühl
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
- Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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15
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Rilk S, Saithna A, Achtnich A, Ferretti A, Sonnery-Cottet B, Kösters C, Bottoni CR, Monaco E, Cavaignac E, Ahlbaeumer G, Brandl G, Mackay GM, Vermeijden HD, Dallo I, Pace JL, van der List JP, Moggia JR, Chahla J, Batista JP, Frosch KH, Schneider KN, Smith PA, Frank RM, Hoogeslag RAG, Eggli S, Douoguih WA, Petersen W, DiFelice GS. The modern-day ACL surgeon's armamentarium should include multiple surgical approaches including primary repair, augmentation, and reconstruction: A letter to the Editor. J ISAKOS 2023; 8:279-281. [PMID: 37023928 DOI: 10.1016/j.jisako.2023.03.434] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Sebastian Rilk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA; Medical University of Vienna, Vienna, 1090, Austria.
| | - Adnan Saithna
- AZBSC Orthopedics, Scottsdale, Arizona, 85255, USA; School of Science & Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK
| | - Andrea Achtnich
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, TU Technische Universität Munich, Munich, 81675, Germany
| | - Andrea Ferretti
- Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, 00197, Italy
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, 69008, France
| | - Clemens Kösters
- Department of Orthopaedic, Hand- and Trauma Surgery, Maria-Josef-Hospital Greven, Greven, 48268, Germany
| | - Craig R Bottoni
- Department of Orthopaedics, Tripler Army Medical Center, Honolulu, Hawaii, 96859, USA
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, 00185, Italy
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, 31300, France
| | - Georg Ahlbaeumer
- Center for Bone and Joint Surgery, Klinik Gut St Moritz, St Moritz, 7500, Switzerland
| | - Georg Brandl
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, 1030, Austria
| | - Gordon M Mackay
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, 1081, the Netherlands
| | | | - J Lee Pace
- Children's Health Andrews Institute Plano, TX, 75024, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, 1081, the Netherlands
| | - Jesús Rey Moggia
- Servicio de Ortopedia y Traumatología, Hospital "General San Martín", La Plata, Argentina; Unidad de Artroscopía y Traumatología Deportiva, Clínica CROMA y Sanatorio IPENSA, La Plata, Argentina
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, IL, 60612, USA
| | - Jorge Pablo Batista
- Boca Juniors Athletic Club Director, Football Medical Department, Brandsen, CABA, Buenos Aires, Argentina
| | - Karl H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany
| | - Kristian N Schneider
- Center for Bone and Joint Surgery, Klinik Gut St Moritz, St Moritz, 7500, Switzerland; Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, 48149, Germany
| | - Patrick A Smith
- Columbia Orthopaedic Group, Columbia, MO, 65201, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, 65201, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, 80045, USA
| | - Roy A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, 7555, the Netherlands
| | - Stefan Eggli
- Department of Orthopaedic Surgery, Sonnenhof Hospital, Bern, 3006, Switzerland
| | - Wiemi A Douoguih
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-Hospital, Berlin, 14193, Germany
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA
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16
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Ferretti A, Carrozzo A, Saithna A, Argento G, Annibaldi A, Latini F, Schirò A, Marzilli F, Monaco E. Comparison of Primary Repair of the Anterior Cruciate Ligament and Anterolateral Structures to Reconstruction and Lateral Extra-articular Tenodesis at 2-Year Follow-up. Am J Sports Med 2023; 51:2300-2312. [PMID: 37350021 DOI: 10.1177/03635465231178301] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Lateral extra-articular procedures have been effective in reducing graft rupture rates after anterior cruciate ligament (ACL) reconstruction (ACLR), but the evidence supporting their role in ACL repair is sparse. PURPOSE/HYPOTHESIS The purpose was to compare clinical and radiological outcomes of ACLR and lateral extra-articular tenodesis (LET) (ACLR+LET) against combined repair of the ACL and anterolateral (AL) structures (ACL+AL Repair). It was hypothesized that patients undergoing ACL+AL Repair would have noninferior clinical and radiological outcomes with respect to International Knee Documentation Committee (IKDC) scores, knee laxity parameters, and magnetic resonance imaging (MRI) characteristics. Furthermore, it was hypothesized that patients undergoing repair would have significantly better Forgotten Joint Score-12 (FJS-12) values and shorter times to return to the preinjury level of sport, without any increase in the rate of ipsilateral second ACL injury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Consecutive patients evaluated with an acute ACL tear were considered for study eligibility. ACLR+LET was only performed when intraoperative tear characteristics contraindicated ACL repair. Patient-reported outcome measures such as the IKDC score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS); reinjury rates; anteroposterior side-to-side laxity difference; and MRI characteristics were reported at a minimum follow-up of 2 years. The noninferiority study was based on the IKDC subjective score; side-to-side anteroposterior laxity difference; and signal-to-noise quotient (SNQ). The noninferiority margins were defined using the existing literature. An a priori sample size calculation was performed using the IKDC subjective score as the primary outcome measure. RESULTS A total of 100 patients (47 ACLR+LET, 53 ACL+AL Repair) with a mean follow-up of 25.2 months (range, 24-31 months) were enrolled and underwent surgery within 15 days of injury. At the final follow-up, the differences between groups with respect to the IKDC score, anteroposterior side-to-side laxity difference, and SNQ did not exceed noninferiority thresholds. ACL+AL Repair was associated with a shorter time to return to the preinjury level of sport (ACL+AL Repair: mean, 6.4 months; ACLR+LET: mean, 9.5 months; P < .01), better FJS-12 values (ACL+AL Repair: mean, 91.4; ACLR+LET: mean, 97.4; P = .04), and a higher proportion of patients achieving the Patient Acceptable Symptom State (PASS) for the KOOS subdomains studied (Symptoms: 90.2% vs 67.4%, P = .005; Sport and Recreation: 94.1% vs 67.4%, P < .001; Quality of Life: 92.2% vs 73.9%, P = .01). There were no significant differences between groups with respect to ipsilateral second ACL injury rates (ACL+AL Repair group, 3.8% and ACLR+LET group, 2.1% [n = 1]; P = .63). CONCLUSION ACL+AL Repair yielded clinical outcomes that were noninferior to (or not significantly different from) ACLR+LET with respect to IKDC subjective, Tegner activity level, and Lysholm scores; knee laxity parameters; graft maturity; and rates of failure and reoperation. However, there were significant advantages of ACL+AL Repair, including a shorter duration of time to return to the preinjury level of sport, better FJS-12 values, and a higher proportion of patients achieving PASS for KOOS subdomains studied (Symptoms, Sport and Recreation, Quality of Life).
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Affiliation(s)
- Andrea Ferretti
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
| | - Alessandro Carrozzo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Argento
- Department of Radiology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Alessandro Annibaldi
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Francesca Latini
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Antonio Schirò
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Fabio Marzilli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Monaco
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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17
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Tapasvi S, Shekhar A. The anterior cruciate ligament: Chronicles of a legend. J ISAKOS 2023; 8:135-136. [PMID: 36924823 DOI: 10.1016/j.jisako.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Sachin Tapasvi
- Chief Consultant, The Orthopaedic Speciality Clinic, Pune, India.
| | - Anshu Shekhar
- Consultant, Sushrut OrthoPlastic Clinic, Raipur, India.
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Hoogeslag R. Anterior cruciate ligament repair: the quest continues (PhD Academy Award). Br J Sports Med 2023:bjsports-2022-106674. [PMID: 36958763 DOI: 10.1136/bjsports-2022-106674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Roy Hoogeslag
- Orthopedisch Centrum Oost Nederland, Hengelo, The Netherlands
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Meng J, Xie D, Meng F, Liu W, Xiao Y, Tang H, Gao S. Clinical outcomes in dynamic intraligamentary stabilization technique for anterior cruciate ligament tear: A meta-analysis. Medicine (Baltimore) 2023; 102:e33091. [PMID: 36897704 PMCID: PMC9997816 DOI: 10.1097/md.0000000000033091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND To compare the clinical outcome between dynamic intraligamentary stabilization (DIS) and anterior cruciate ligament (ACL) reconstruction in ACL tears. METHODS PubMed, the Cochrane Library, and Embase databases were searched to identify published articles on clinical studies comparing DIS versus ACL reconstruction. The results of the eligible studies were analyzed in terms of anteroposterior knee laxity translation (ΔATT) between the injured and contralateral knees, and subjective International Knee Documentation Committee (IKDC), Lysholm score, Tegner score, and ipsilateral ACL failure, implant removal, and ACL revision. RESULTS Five clinical studies including 429 patients with ACL tears met the inclusion criteria. DIS showed statistically comparable outcomes of ΔATT (P = .12), IKDC (P = .38), Tegner (P = .82), ACL failure (P = .50), ACL revision (P = .29) with ACL reconstruction. A significantly higher rate of implant removal (odds ratio for DIS vs ACL reconstruction, 7.73; 95% confidence interval [CI], 2.72-22.00; P = .0001) but statistically higher Lysholm score (mean difference between DIS and ACL reconstruction, 1.59; 95% CI, 0.24-2.93; P = .02) were found in DIS group. CONCLUSION Five clinical studies including 429 patients with ACL tears met the inclusion criteria. DIS showed statistically comparable outcomes of ΔATT (P = .12), IKDC (P = .38), Tegner (P = .82), ACL failure (P = .50), ACL revision (P = .29) with ACL reconstruction. A significantly higher rate of implant removal (odds ratio for DIS vs ACL reconstruction, 7.73; 95% CI, 2.72-22.00; P = .0001) but statistically higher Lysholm score (mean difference between DIS and ACL reconstruction, 1.59; 95% CI, 0.24-2.93; P = .02) were found in DIS group.
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Affiliation(s)
- Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fanqiang Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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20
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Clinical Research Progress of Internal Brace Ligament Augmentation Technique in Knee Ligament Injury Repair and Reconstruction: A Narrative Review. J Clin Med 2023; 12:jcm12051999. [PMID: 36902785 PMCID: PMC10004357 DOI: 10.3390/jcm12051999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Knee ligament injuries are most common in sports injuries. In general, ligament repair or reconstruction is necessary to restore the stability of the knee joint and prevent secondary injuries. Despite advances in ligament repair and reconstruction techniques, a number of patients still experience re-rupture of the graft and suboptimal recovery of motor function. Since Dr. Mackay's introduction of the internal brace technique, there has been continuous research in recent years using the internal brace ligament augmentation technique for knee ligament repair or reconstruction, particularly in the repair or reconstruction of the anterior cruciate ligament. This technique focuses on increasing the strength of autologous or allograft tendon grafts through the use of braided ultra-high-molecular-weight polyethylene suture tapes to facilitate postoperative rehabilitation and avoid re-rupture or failure. The purpose of this review is to present detailed research progress in the internal brace ligament enhancement technique of knee ligament injury repair as well as the reconstruction from biomechanical and histological research and clinical studies and to comprehensively assess the value of the application of this technique.
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21
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Glasbrenner J, Raschke MJ, Kittl C, Herbst E, Peez C, Briese T, Michel P, Herbort M, Kösters C, Schliemann B. Comparable Instrumented Knee Joint Laxity and Patient-Reported Outcomes After ACL Repair: Response. Am J Sports Med 2023; 51:NP12-NP14. [PMID: 36856284 PMCID: PMC9983043 DOI: 10.1177/03635465221144035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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22
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Zheng T, Cao Y, Song G, Li Y, Zhang Z, Feng Z, Zhang H. Suture tape augmentation, a novel application of synthetic materials in anterior cruciate ligament reconstruction: A systematic review. Front Bioeng Biotechnol 2023; 10:1065314. [PMID: 36686239 PMCID: PMC9850216 DOI: 10.3389/fbioe.2022.1065314] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/21/2022] [Indexed: 01/04/2023] Open
Abstract
Objective: Suture tape (ST) is a common synthetic material in the repairing surgery of soft tissue. Recently, ST augmentation (STA) technique has been described as a novel way to improve the mechanical property of grafts in the anterior cruciate ligament (ACL) reconstruction (ACLR). However, the clinical outcomes of ACLR using ST-augmented grafts have not been clarified. This systematic review aimed to summarize the specific technique of STA and evaluate the clinical outcomes after ACLR with STA. Methods: A electronic search of PubMed and Embase databases with a manual search of Google Scholar was performed to identify studies that reported the clinical outcomes of ACLR with STA. Each included study was abstracted regarding the study features, patient data, surgical information, and outcome measures. Results: Nine studies were included, representing 314 knees in 314 patients undergoing ACLR with STA. Technically, ST was fixed independently from grafts in six studies and along with grafts in two studies. Most studies applied an equal or slightly less tension on ST than ACL graft. Clinically, significant improvements were found in the Lysholm, IKDC, and KOOS scores after a mean follow-up of 16.7 months. Physical examinations of 220 patients showed significant restoration of knee stability at the final follow-up. 59 of 80 (73.8%) patients returned to preinjury sports level at a minimum 2 year follow-up. Six of 266 (2.3%) patients had a graft failure during the first 2 years postoperatively. The use of ST was significantly associated with better Tegner scores and a trend toward significantly higher rates of return to sport compared to standard ACLR. No significant difference was found in most subjective scores, knee laxity, and graft failures between ACLR with or without STA. Conclusion: ACLR with STA achieved overall favorable clinical outcomes. Patients using ST-augmented grafts were seemingly associated with better sports performance compared to standard ACLR. But ACLR with STA was not superior to ACLR alone in most functional scores, knee stability measures, and graft failure rates. A tension equal to or slightly less than the ACL graft should be carefully applied on ST during fixation to avoid stress shielding of the graft.
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23
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Reider B. ACL Blasts From Past to Present. Am J Sports Med 2022; 50:3169-3173. [PMID: 36177752 DOI: 10.1177/03635465221124138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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