Anterior cruciate ligament repair with Independent Suture Tape Reinforcement: a case series with 2-year follow-up

Abstract

Purpose The treatment of acute anterior cruciate ligament (ACL) ruptures with a repair technique has recently regained interest. A novel ACL repair technique was described using Independent Suture Tape Reinforcement with 2-year follow-up results. Methods Forty-two consecutive patients with an acute ACL rupture undergoing repair using this technique were followed up for a minimum of 2 years. Patients with mid-substance, distal ACL ruptures, poor ACL tissue quality or retracted ACL remnants as well as patients with multi-ligament injuries were excluded. Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12 Item Health Survey (VR-12) and the Marx Activity scale were collected by online questionnaires. Two-year postoperative patients were asked by telephone if they had experienced a rerupture. Results All the KOOS subscales improved signiicantly in comparison to the preoperative score. The largest improvement of all scores was seen at 3 months postoperatively which is signiicant in all cases. The KOOS sport and recreation showed a meaningful change and the largest improvement of the KOOS subscales at 3 months postoperatively, as well as the highest total improvement at 1 year postoperatively compared to preoperatively. The VAS-pain and VR-12 physical score improved signiicantly, however the Marx activity scale decreased signiicantly in comparison to preoperative scores. Two patients reported a rerupture (4.8%, CI 1.7-11.2%). Conclusions This is the irst case series that described the 2-year follow-up results of patients with an acute, proximal ACL rupture, treated with the Independent Suture Tape Reinforcement repair technique. A meaningful KOOS sport and recreation change and signiicant improvements in the KOOS, VAS-pain and VR-12 physical scores as well as a signiicant decrease of the Marx activity scale in comparison to preoperative scores are demonstrated. Two of the 42 patients (4.8%) reported an ACL rerupture. Repair with this technique could be clinically relevant as a treatment option for patients with an acute, proximal ACL rupture which is not retracted and of good tissue quality. Level of evidence IV.

Clinical Outcomes of Arthroscopic Primary Anterior Cruciate Ligament Repair: A Systematic Review from the Scientific Anterior Cruciate Ligament Network International Study Group

“…These studies also highlight that the DIS Ligamys technique was associated with a high rate of complications, and this may explain the significant deterioration in results. Heusdens et al 47 also reported a deterioration in outcomes following ACL repair with internal bracing, but this finding was not significant. The authors reported that at 12 months postoperatively all components of the Knee injury and Osteoarthritis Outcome Score, VR-12, and visual analog scale for pain showed a significant improvement compared with preoperative scores but that they deteriorated between 12 and 24 months.…”

“…The remaining 14 studies were Level IV cases series. [40][41][42][43][44][45][46][47][48][49][50][51][52][53] The flowchart for the search strategy is depicted in Figure 1.…”

“…A total of 1002 patients who underwent arthroscopic primary ACL repair formed the overall population evaluated in this systematic review. These patients underwent ACL repair with either suture anchor repair (SAR) (n ¼ 158), 37,39,42,46,48,49 dynamic intraligamentary stabilization with Ligamys (DIS Ligamys) (n ¼ 779), 35,36,40,41,43,44,[50][51][52][53] bridge-enhanced ACL repair technique (i.e., BEAR) (n ¼ 10), 38 suture pullout repair (n ¼ 13), 45 or augmented ACL repair using suture tape reinforcement with internal brace (IB) (Internal Brace Ligament Augmentation Repair; Arthrex, Naples, FL) 47 (n ¼ 42).…”

“…the groups. Heusdens et al 47 also reported the outcomes of ACL repair with internal bracing. The authors did not report the same outcome measures used by most studies.…”

“…Seventeen of the included studies [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]52,53 reported the postoperative rehabilitation and return to sport protocols and these are summarized in Table 6. All of the comparative studies used the same rehabilitation protocol in both ACL repair and reconstruction groups.…”