High complication rate following dynamic intraligamentary stabilization for primary repair of the anterior cruciate ligament

Osti, Michael; Attal, R.; Doskar, Wolfgang; Höck, Paul; Smekal, Vinzenz

doi:10.1007/s00167-018-5067-3

Cited by 42 publications

(55 citation statements)

References 26 publications

(73 reference statements)

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“…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.…”

Section: Clinical Outcomes Reported In Comparative Studiesmentioning

confidence: 93%

“…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.…”

Section: Study Selectionmentioning

confidence: 99%

“…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).…”

Section: Arthroscopic Primary Acl Repair Techniquesmentioning

confidence: 99%

“…These include the demographic characteristics, surgical techniques used, and details of the injury and follow-up. 36 2018 Van der List and DiFelice, 37 2017 Murray et al, 38 2016 Achtnich et al, 39 2016 Kohl et al, 40 2016 Bigoni et al, 42 2016 Ateschrang et al, 43 Osti et al, 44 DiFelice and van der List, 48 53 26 AE 10 32/45 (71.1%)…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…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. Two studies 44,50 reported a significant deterioration in Tegner activity score at 1-year postoperatively. Osti et al 44 reported a significant deterioration from the preoperative median Tegner activity score of 7 (4-9) to 5 (0-9) (P < .05) at 12 months following DIS Ligamys ACL repair.…”

Section: Clinical Outcomes Reported In Comparative Studiesmentioning

confidence: 99%

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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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Section: Clinical Outcomes Reported In Comparative Studiesmentioning

confidence: 93%

“…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.…”

Section: Study Selectionmentioning

confidence: 99%

Section: Arthroscopic Primary Acl Repair Techniquesmentioning

confidence: 99%

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Clinical Outcomes Reported In Comparative Studiesmentioning

confidence: 99%

See 3 more Smart Citations

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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show abstract

Who Needs ACL Surgery?

Lin

James

Marx

2021

Advances in Knee Ligament and Knee Preservation Surgery

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Improved results of ACL primary repair in one-part tears with intact synovial coverage

Ateschrang

Schreiner

Ahmad

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose It was the aim to assess the influence of synovial sheath disruption on early failure of primary anterior cruciate ligament (ACL) repair. It was hypothesized that more-part ACL tears with disruption of the synovial sheath are associated with a higher risk of failure after primary ACL repair. Methods A cohort study was conducted comprising patients with primal ACL tears undergoing primary ACL repair and dynamic intraligamentary stabilization (DIS). The patients were stratified into three groups: A-one-part rupture with intact synovial membrane (n = 50), B-two-part ruptures resultant to separation of the ACL into two main bundles with synovial membrane tearing (n = 52) and C-more parts involving multilacerated ruptures with membrane disruption (n = 22). Failure was defined as a retear or residual laxity (anterior posterior translation > 5 mm compared to healthy knee). Adjustment for potential risk factors was performed using a multivariate logistic-regression model. ResultsThe overall failure rate was 17.7% throughout the mean follow-up period of 2.3 ± 0.8 years. The failure rate in patients with one-part ACL tears with an intact synovial membrane was 4% (n = 2) (Group A), which was significantly lower than the failure rates in groups B and C, 26.9% (n = 14) (p = 0.001) and 27.3% (n = 6) (p = 0.003), respectively. Disruption of the synovial sheath in two-or more-part tears was identified as an independent factor influencing treatment failure in primary ACL repair (OR 8.9; 95% CI 2.0-40.0). ConclusionThe integrity of the ACL bundles and synovial sheath is a factor that influences the success of ACL repair. This needs to be considered intra-operatively when deciding about repair. Level of evidence IV.

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High complication rate following dynamic intraligamentary stabilization for primary repair of the anterior cruciate ligament

Abstract: IV (prospective case series).

Cited by 42 publications

References 26 publications

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

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

Who Needs ACL Surgery?

Improved results of ACL primary repair in one-part tears with intact synovial coverage

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