Anterior Cruciate Ligament (ACL) Reconstruction Augmented With Bone Marrow Concentrate, Demineralized Bone Matrix, Autograft Bone, and a Suture Tape (The Fertilized ACL)

Abstract

Purpose: To examine the early clinical outcomes as well as safety of the Fertilized anterior cruciate ligament (ACL) reconstruction procedure. Methods: A total of 16 consecutive patients with a mean age of 24 years (range, 16-45 years), who had been treated with the fertilized ACL were evaluated and followed over 2 years. Four patients underwent reconstruction using an FGL GRAFTLINK allograft (LifeNet Virginia Beach, VA) and 12 using quadriceps autografts. All patients received the fertilized ACL as previously described using bone marrow composite, demineralized bone matrix, and an internal brace (Arthrex, Largo, FL). Clinical outcomes at 2 years including International Knee Documentation Committee and Marx scores were evaluated. Complication rates, including return to operating room, arthrofibrosis, infection, and rerupture rates, were also assessed. Results: All patients were followed for 6 months and all were released to full activity. In total, 11 of 16 patients were available for 2-year follow-up after the fertilized ACL reconstruction. At 2 years, the average International Knee Documentation Committee and Marx scores were 81 (standard deviation, 5.9) and 9 (standard deviation, 5.7), respectively. One patient required a return trip to the operating room for manipulation under anesthesia. No reruptures were observed at the 2-year mark. Nine of 11 patients had returned to their preinjury activity status at 2 years. Conclusions: The fertilized ACL, which adds biology and an internal brace to an ACL reconstruction, is a reliable and safe option when performing an ACL reconstruction. Very low complication risks were seen in this consecutive series followed for 2 years. Patients consistently returned to their preinjury activity status. Level of Evidence: Level IV, therapeutic case series.

Analysis of Graft Types Augmented With an Internal Brace for ACL Reconstruction: A Systematic Review

“…Overall, these 3 studies showed low risk of bias. Lavender et al 14 received a moderate risk of bias in selection of participants into the study because of the low number of overall participants (n = 16; n = 11 followed up over 2 years), as well as moderate risk of bias in measurement of outcomes and selection of the reported result.…”

“…Two studies included findings of patients who underwent ACLR with ST reinforcement of a QT autograft with findings included in Appendix Table A4 (available online). 14,41 Lavender et al 14 found that all patients had a negative Lachman and pivot-shift examination with no subjective instability. Seven of 11 (64%) patients reported their knee felt good and 4 (36%) reported their knee felt average, but the breakdown between autograft and allograft was not reported.…”

Suture tape augmentation, a novel application of synthetic materials in anterior cruciate ligament reconstruction: A systematic review

“…Critical application of the inclusion and exclusion criteria finally yielded nine studies ( Figure 2 ). One was a prospective cohort study (level 2) ( Shantanu et al, 2019 ), six were retrospective cohort studies (level 3) ( Bodendorfer et al, 2019 ; Parkes et al, 2021 ; Allom et al, 2022 ; Kitchen et al, 2022 ; Szakiel et al, 2022 ; von Essen et al, 2022 ), and two were case series (level 4) ( Lavender et al, 2021 ; Duong et al, 2022 ). All seven comparative studies were designed to compare patients who underwent ACLR with and without ST-augmented grafts ( Table 2 ).…”

“…Seven studies compared subjective scores between pre- and postoperative status for ACLR with STA, and significant improvement was reported in six studies. Those used at least in two studies included the Lysholm score from 61.2 to 91.2 ( Shantanu et al, 2019 ; Duong et al, 2022 ), IKDC score from 30.7 to 85.8 ( Bodendorfer et al, 2019 ; Lavender et al, 2021 ), and KOOS score from 60.9 to 89.1 ( Bodendorfer et al, 2019 ; Szakiel et al, 2022 ; von Essen et al, 2022 ). The IKDC grade was reported in one study ( Duong et al, 2022 ) with the grade (A/B/C/D) from 0/0/19/18 to 30/7/0/0.…”

Effects of Platelet-Rich Osteoconductive–Osteoinductive Allograft Compound on Tunnel Widening of ACL Reconstruction: A Randomized Blind Analysis Study

“…The OIC materials have been heralded as osteogenic [ 17 ]. As further evidence, a recent clinical study with a follow-up at two years has shown that the use of DBM provides an internal brace to the ACL and represents a reliable and safe option when performing ACL construction [ 26 ]. Such a study was conducted on patients with a similar age range as of those participating in the present research.…”