A Narrative Review of Four Different New Techniques in Primary Anterior Cruciate Ligament Repair: “Back to the Future” or Another Trend?

Abstract

Recently, four different operative techniques, referring to the primary anterior cruciate ligament (ACL) repair, were described. These are the dynamic intraligamentary stabilization (DIS) with Ligamys™, the Bridge-enhanced repair (BEAR), the use of internal brace, and the refixation with suture anchors. The purpose of this study was to assess the already-published, clinical, and pre-clinical results of those techniques. A literature review was conducted and implemented by three independent researchers. Inclusion criteria were clinical or cadaveric or animal studies about patients suffering from ACL rupture, who were treated with one of those four different arthroscopic techniques of primary ACL repair. There were 10 clinical trials dealing with the different techniques of primary ACL repair and 12 cadaveric or animal studies. The majority of the published clinical trials investigated the dynamic intraligamentary stabilization (DIS), while only four studies referred to the three other surgical techniques. Most of the clinical trials suggested that primary ACL repair should be done during the first 14–21 days after a proximal ACL rupture and not later. Further clinical evidence is needed for the techniques of bridge-enhanced ACL repair, internal brace, and suture anchors ACL refixation in order to support the animal and cadaveric biomechanical studies. Till now, the existing clinical trials were not enough to establish the use of those techniques in the ACL-ruptured patients. On the contrary, the Dynamic intraligamentary stabilization with Ligamys™ device demonstrated very promising results in different types of clinical studies.

ACL Repair: A Game Changer or Will History Repeat Itself? A Critical Appraisal

“…The number of reviews on ACL repair is remarkable. In the past four years, 12 reviews have been published on ACL repair [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. The overall consensus in these reviews is that prospective studies comparing ACL repair with ACL recon with sufficient follow-up are needed.…”

New grafts for anterior cruciate ligament grafting using the «all-inside» method

“…За даними різних авторів, рецидиви, пов'язані з ушкодженням трансплантата ПСЗ досягають 5-14 %. Повернення пацієнта на колишній рівень фізичної активності після операції ще менше -від 54 до 86 % [1][2][3][4].…”

“…За умов підвісної фіксації неповне заповнення каналу трансплантатом може призвести до потрапляння поруч із ним синовіальної рідини. Це все порушує інтеграцію та спричинює додатковий ризик розширення каналу [2,[10][11][12].…”

“…Удосконалення методики пластики ПСЗ відбувається у таких напрямках: зменшення операційної травми, поліпшення анатомічного розташування трансплантата, підвищення міцності його кріплення, стимуляція регенерації місць кріплення, модифікація післяопераційного відновного лікування [1][2][3]13].…”

The Reconstruction of the Anterior Cruciate Ligament on the Background of Knee Osteoarthritis

“…There is a constant development of methods of the reconstruction of the anterior cruciate ligament which, in its turn, primarily connected with a more accurate positioning of the graft attachment. There is a polemic in progress dedicated to the choice of the graft for the reconstruction of the anterior cruciate ligament and the ways of its attachment [1][2][3][4][5]. However, the instability backsets occur in 5-25 % of the cases and the level of patients returning to sport after the plastic reconstruction of the anterior cruciate ligament is from 60 to 80 % [1][2][3][4][5][6][7][8].…”