Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation

Krismer, Anna; Gousopoulos, Lampros; Kohl, Sandro; Ateschrang, Atesch; Kohlhof, Hendrik; Ahmad, Sufian S.

doi:10.1007/s00167-017-4445-6

Cited by 62 publications

(90 citation statements)

References 14 publications

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“…Ruptures located in the proximal third of the ACL are proposed to have the best healing potential. 35,52,56,58 In the present review and contrary to the NA and SA ACLSR categories, the majority of the studies in the DA ACLSR category evaluated combined or middle third ACL ruptures, which could therefore have negatively influenced failure and other complication rates in DA ACLSR. However, a vast reduction in failure rate as well as other complication rates was observed after the addition of a bridging collagen scaffold to middle third ruptures in DA ACLSR.…”

Section: Discussionmentioning

confidence: 77%

“…Only 9 justified their choice of sample size before the study by means of a power calculation or descriptive justification (ie, first-in-human study). 1,4,7,10,15,19,27,35,50 Transparent and/or unbiased group assignment, to reduce the risk of contamination bias, was adequately addressed in just 4 studies. 7,15,27,50 Furthermore, only 7 studies adequately addressed cointervention by providing information about the rehabilitation protocol and/or concomitant cartilage damage and multiligamentous knee injury.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature

et al. 2020

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Background: Anterior cruciate ligament suture repair (ACLSR) was abandoned late last century in favor of anterior cruciate ligament (ACL) reconstruction (ACLR) because of overall disappointing results. However, in recent years there has been renewed and increasing interest in ACLSR for treatment of ACL ruptures. Several contemporary ACLSR techniques are being used, but any difference in effectiveness is unclear. Hypothesis: Contemporary nonaugmented (NA), static augmented (SA), and dynamic augmented (DA) ACLSR leads to (1) comparable outcomes overall and (2) comparable outcomes between proximal third, middle third, and combined ACL rupture locations (a) within and (b) between ACLSR technique categories. Study Design: Systematic review. Methods: An electronic search was performed in the MEDLINE and Embase databases for the period between January 1, 2010, and August 7, 2019. All articles describing clinical and patient-reported outcomes for ACLSR were identified and included, and outcomes for NA, SA, and DA ACLSR categories were compared. Results: A total of 31 articles and 2422 patients were included. The majority of articles (65%) and patients (89%) reported outcomes of DA ACLSR. Overall, there was high heterogeneity in study characteristics and level as well as quality of evidence (19 level 4; 7 level 3; 3 level 2; and 2 level 1). Most studies indicated excellent patient-reported outcomes. Overall, the variability in (and the maximum of) the reported failure rate was high within all ACLSR categories. The variability in (and the maximum of) the reported rate of all other complications was highest for DA ACLSR. Regarding ACL rupture location, the failure rate was highest in proximal ACL ruptures within the SA and DA ACLSR categories; rates of all other reported complications were highest in combined ACL ruptures within the DA ACLSR category. However, no studies in the NA category and only 1 study in the SA ACLSR category evaluated combined ACL ruptures. The majority of studies comparing ACLSR and ACLR found no differences in outcomes. Conclusion: The amount of high-quality evidence for contemporary ACLSR is poor. This makes it difficult to interpret differences among ACLSR categories and among ACL rupture locations and, though promising, to establish the role of ACLSR in the treatment of ACL ruptures. More high-quality large randomized clinical trials with longer follow-up comparing ACLSR and ACLR are needed.

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Section: Discussionmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature

et al. 2020

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“…In contrast some of the included studies evaluating the DIS Ligamys repair technique did not consider tear location in the eligibility criteria. 35,36,44,50,51,53 A recent study by Krismer et al 57 evaluated the factors influencing the success of the DIS Ligamys technique. They identified mid-substance tears as an important predictor for inferior functional outcomes and revision ACL surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Kandhari

Vieira

Ouanezar

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To perform a systematic review of contemporary studies reporting clinical outcomes of primary anterior cruciate ligament (ACL) repair to determine whether these studies demonstrate any significant benefit of ACL repair and whether there is evidence of a deterioration of mid-term outcomes as seen in historical data. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A PubMed search using the keywords "repair" AND "Anterior Cruciate Ligament" was performed (limits: English language, publication date between January 1, 2014, and January 13, 2019). All identified studies reporting clinical outcomes of arthroscopic ACL repair were included. Critical appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Clinical Trials and the Methodological Index for Non-Randomized Studies. Basic parameters of each study including population characteristics, repair technique, physical examination findings, and clinical outcome scores were recorded and evaluated. Results: Nineteen eligible studies were identified (including 5 comparative studies). None of the comparative studies showed any significant difference between repair and reconstruction groups with respect to International Knee Documentation Committee (IKDC), Lysholm, Tegner, side-to-side laxity difference, Lachman, pivot shift tests, or graft rupture rates. Four non-comparative studies reported outcomes at medium-to long-term follow up (range of mean follow up 43.3-79 months) with a mean Lysholm score between 85.3 and 100, mean IKDC subjective score between 87.3 and 100, and mean Tegner activity score between 5 and 7. Conclusions: Comparative studies identified no significant differences between ACL repair and reconstruction with respect to Lysholm, IKDC, side-to-side laxity difference, pivot shift grade, or graft rupture rates. However, these studies had major limitations including small numbers and short durations of follow up. Case series demonstrated that excellent outcomes can be achieved at medium-to long-term follow up with the SAR technique. Level of Evidence: IV; Systematic review of Level II to IV investigations. See related article on page 613 H istorical results of open primary repair of the anterior cruciate ligament (ACL) have been characterized in the literature by good initial clinical outcomes, 1-6 with a significant deterioration at midterm follow-up and high rates of additional surgery (64%), including reoperation for ACL reconstruction (13%

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“…It appears bio-enhancement of the ACL repair with a collagen scaffold infused with PRP or MSCs also shows some promise. There is clearly still some way to go to determine whether these techniques will translate to significant benefits for athletes, particularly as they appear to be in a higher risk group for repair failure (Henle et al 2017 ; Krismer et al 2017 ). However, with careful patient selection failure rates are broadly comparable with ACL reconstruction and several unanswered questions remain that provide avenues for further exploration that may yet yield benefits for repair over reconstruction e.g.…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament repair – past, present and future

2018

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BackgroundThis article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing.Current standardThe poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries.History of primary ACL repairThe history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed.New primary repair techniquesThere has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur.In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair.Bio enhanced repairIn addition, biological supplementation is being investigated as an adjunct and we will review the current literature with regards to bio-enhancement in the form platelet rich plasma, bio-scaffolds and stem cells. On the basis of current evidence, there appears to be a role for bio-enhancement, however, this is not yet translated into clinical practice.ConclusionsSeveral promising avenues of further research now exist in the form of mechanical and biological augmentation techniques. Further work is clearly needed but there is renewed interest and focus for primary ACL repair that may yet prove the new frontier in ligament repair.

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Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation

Abstract: II.

Cited by 62 publications

References 14 publications

Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature

Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature

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

Anterior cruciate ligament repair – past, present and future

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