Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing

Abstract

PurposeRecent outcomes of arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears have been promising in small cohort studies. The purpose of this study was to assess outcomes of arthroscopic ACL repair in a larger cohort and to assess the role of additional augmentation. MethodsThe first 56 consecutive patients that underwent arthroscopic ACL repair were examined at minimum 2‐year follow‐up. The latter 27 patients [48.2% (27/56)] received additional internal bracing with ACL repair. All 56 patients were included (100% follow‐up). Mean age at surgery was 33.5 ± 11.3 years (59% male) and mean follow‐up 3.2 ± 1.7 years. Clinical examination was performed using the objective International Knee Documentation Committee (IKDC) form. Subjective outcomes were obtained using the Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation (SANE), and subjective IKDC scores. ResultsSix repairs (10.7%) failed and four additional patients underwent reoperation (7.1%): two for meniscus tears and two for suture anchor irritation. Objective IKDC scores were A in 38 (73%), B in 8 (15%) and C/D in 6 (12%) patients. Mean Lysholm score was 94 ± 7.6, modified Cincinnati 94 ± 8.9, SANE 90 ± 12.5, pre‐injury Tegner 6.7 ± 1.5, current Tegner 6.2 ± 1.5, and subjective IKDC 90 ± 10.9. Failures rates were 7.4% with and 13.8% without internal bracing (P = 0.672). There were no statistically significant or clinically relevant differences in subjective outcomes. ConclusionArthroscopic primary repair has resulted in good objective and subjective outcomes at 3.2‐year follow‐up in a carefully selected population. The role of additional internal bracing is possibly beneficial, but larger groups are needed to assess this. Level of evidenceIII.

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

“…reported outcomes at medium-to long-term follow-up (range of mean follow-up 43.3-79 months) 41,48,49,52 including the mean IKDC subjective score (range 87.3-100), the mean Lysholm score (range 85.3-100), and the mean Tegner activity score (range 5-7). The remaining 10 studies 36,40,[42][43][44][45][46]50,51,53 reported the same outcome measures at short-term follow-up (range of mean follow up 12-38.4 months). At final follow-up, these studies reported a mean IKDC subjective score of 89.5-98, a mean Lysholm score of 93-100, and a mean Tegner activity score of 5-7.…”

“…The most frequent reoperation was ACL reconstruction. Hoffman et al 49 reported an ACL reconstruction rate of 16.7% at a mean follow-up of 79 months, and Jonkerouw et al, 46 7.1% at 38 months. In the only study that compared outcomes of ACL repair with and without IB, Jonkerouw et al 46 reported that there was no significant difference in the failure rate between repairs performed with IB (2/27; 7.4%) and those without (4/29; 13.8%, P ¼ .672).…”

“…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).…”

“…Two studies reported the clinical results of ACL repair associated with internal bracing. Jonkergouw et al 46 reported the outcomes of patients who underwent SAR with or without suture tape reinforcement (Internal Brace Ligament Augmentation Repair; Arthrex). There were no statistically significant or clinically relevant differences in subjective outcomes (Table 4) Relook arthroscopy was performed as a protocol of the study.…”