Preservation of the Anterior Cruciate Ligament: Arthroscopic Primary Repair of Proximal Tears

List, Jelle P. van der; Jonkergouw, Anne; DiFelice, Gregory S.

doi:10.1007/978-3-030-57382-9_17

Cited by 8 publications

(12 citation statements)

References 76 publications

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“…As expected, time from injury to surgery was significantly shorter in the ACL-IB group, as primary repair of the torn ACL is best performed within a time frame of approximately 3 weeks before circulation of the stump is compromised and advanced scar tissue formation of the torn ligament is present. 53 Interestingly, even if concomitant injuries and surgeries performed along with the ACL surgery did not differ among both groups, the overall surgery time was significantly shorter for the ACL-IB group. To the best of our knowledge, to date no other study comparing ACL-IB and ACL-R investigated this aspect.…”

Section: Discussionmentioning

confidence: 85%

“…40 Ultimately, the abovementioned factors combined could result in less postoperative tissue swelling and effusion, faster return to full ROM, faster postoperative rehabilitation, better preservation/restoration of muscle strength, and earlier return to work and sports compared with ACL-R. 3,17,36,52 The remarkable evolution of arthroscopic techniques and devices along with recently published promising clinical results have resurrected interest in primary repair of proximal ACL tears. 17,25,28,61 Several approaches have been reported with or without reinforcement of the native ACL, 31,53,62 and improved outcomes, including a significantly lower failure rate, have been reported. 28 A frequently used technique in ACL repair and augmentation for proximal ACL ruptures is the InternalBrace (ACL-IB; Arthrex Inc).…”

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confidence: 99%

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Favorable Patient-Reported, Clinical, and Functional Outcomes 2 Years After ACL Repair and InternalBrace Augmentation Compared With ACL Reconstruction and Healthy Controls

Müller,

Bühl,

Nüesch

et al. 2023

Am J Sports Med

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Background: Recently, interest in anterior cruciate ligament (ACL) preservation and repair after proximal ACL tears has been resurrected. Although good clinical outcomes have been reported in the literature with adequate patient selection, to date detailed scientific evidence for the functional benefit of primary ACL repair with ligament augmentation is scarce. Purpose: To compare patient-reported, clinical, and functional outcomes in patients 2 years after ACL repair and InternalBrace augmentation (ACL-IB) with age- and sex-matched patients 2 years after ACL reconstruction (ACL-R) and with matched healthy controls. Study Design: Cohort study; Level of evidence, 3. Methods: In total, 29 patients 2 years after ACL-IB, 27 sex- and age- matched patients 2 years after ACL-R (hamstring autografts), and 29 matched healthy controls were included. Patient-reported outcomes were assessed using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, EQ-5D-5L, Tegner Activity Scale, and Anterior Cruciate Ligament Return to Sports after Injury scale. Surgery time was recorded. For clinical outcomes, range of motion and thigh and shank circumference were measured, and passive anterior translation was determined using the Rolimeter. Isokinetic muscle strength was measured using a Biodex dynamometer. The limb symmetry index (operated/contralateral or nondominant/dominant × 100), side-to-side differences (operated – contralateral, nondominant – dominant), and hamstring-quadriceps ratios were calculated for functional parameters. Failure and reoperation rates were not compared. Results: Two years after surgery, patients treated with ACL-IB showed good to excellent patient-reported outcomes comparable with those of patients after ACL-R. Surgery time, including concomitant surgeries, was significantly shorter in the ACL-IB group (mean, 81 minutes) compared with the ACL-R group (mean, 97 minutes) ( P = .024). Isokinetic muscle strength was comparable between patient groups without significant differences in extensor and flexor strength or in hamstring-quadriceps ratios. Conclusion: These results suggest that ACL-IB achieves comparable patient-reported, clinical, and functional outcomes with ACL-R at 2 years postoperatively and, after careful patient selection, should be considered as a valuable early treatment alternative for proximal ACL tears. Registration: NCT04429165 (ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 85%

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confidence: 99%

Favorable Patient-Reported, Clinical, and Functional Outcomes 2 Years After ACL Repair and InternalBrace Augmentation Compared With ACL Reconstruction and Healthy Controls

Müller,

Bühl,

Nüesch

et al. 2023

Am J Sports Med

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“…Between December 2019 and July 2022, all patients were treated using a previously described treatment algorithm in which patients with proximal ACL tears and sufficient tissue quality underwent primary ACL repair, while a standard ACLR was performed otherwise. 24 Inclusion criteria were patients (1) aged between 18 and 55 years (2) and treated with primary repair or ACLR (either with quadriceps tendon [QT] or hamstring tendon [HT] autograft). Exclusion criteria were patients with (1) a history of preoperative opioid use (defined as opioid use within 3 months of surgery), (2) ACL revision surgery, (3) multiligament knee injuries, (4) bilateral knee injuries, (5) or insufficient follow-up.…”

Section: Methods Patient Selectionmentioning

confidence: 99%

Prospective Comparison of Postoperative Pain and Opioid Consumption Between Primary Repair and Reconstruction of the Anterior Cruciate Ligament

Vermeijden,

Holuba,

Yang

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with postoperative pain and necessitates using perioperative nerve blocks and multimodal analgesic plans. Purpose: To assess postoperative pain and daily opioid use after ACL repair versus ACLR and to assess whether ACL repair could be performed successfully without using long-acting nerve blocks. Study Design: Cohort study; Level of evidence, 2. Methods: All eligible patients who underwent ACL surgery between 2019 and 2022 were prospectively enrolled. Patients were treated with primary repair if proximal tears with sufficient tissue quality were present; otherwise, they underwent single-bundle ACLR with either hamstring tendon or quadriceps tendon autograft. The patients were divided into 3 groups: ACLR with adductor canal nerve block (up to 20 mL of 0.25% bupivacaine with 2 mg dexamethasone), primary repair with nerve block, and primary repair without nerve block. Pain visual analog scale and number of opioids used were recorded during the first 14 postoperative days (PODs). Furthermore, patients completed the Quality of Recovery-15 (QoR-15) survey, and range of motion was assessed. Group differences were compared using Mann-Whitney U test and chi-square test. Results: Seventy-eight patients were included: 30 (39%) underwent ACLR, 19 (24%) ACL repair with nerve block, and 29 (37%) ACL repair without nerve block. Overall, the ACL repair group used significantly fewer opioids than the ACLR group on POD 1 (1 vs 3, P = .027) and POD 2 (1 vs 3, P = .014) while also using fewer opioids in total (3 vs 8, P = .038). This difference was even more marked when only analyzing those patients who received postoperative nerve blocks (1 vs 8, P = .029). Repair patients had significantly higher QoR-15 scores throughout the first postoperative week, and they had greater range of motion (all P < .05). There were no significant differences in pain scores, opioid usage, or QoR-15 scores between patients who underwent repair with versus without nerve block. Conclusion: The ACL repair group experienced less postoperative pain during the first 2 weeks after surgery and used significantly fewer opioids than the ACLR group. Furthermore, they had improved knee function and higher recovery quality than patients who underwent ACLR during the initial postoperative period. Postoperative nerve blocks may not be necessary after ACL repair.

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“…Proximal ruptures of the ACL are repaired with suture tape augmentation. A proximal tear was deined as having a long enough distal remnant for reattachment to the femoral footprint which equates to type I and type II tears in the modiied Sherman classiication described by Van der List et al [46].…”

Section: Surgical Techniquementioning

confidence: 99%

Satisfactory patient-reported outcomes at 5 years following primary repair with suture tape augmentation for proximal anterior cruciate ligament tears

Hopper

Aithie

Jenkins

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose An enhanced understanding of anterior cruciate ligament (ACL) healing and advancements in arthroscopic instrumentation has resulted in a renewed interest in ACL repair. Augmentation of a ligament repair with suture tape reinforces the ligament and acts as a secondary stabilizer. This study assesses the 5-year patient-reported outcomes of primary repair with suture tape augmentation for proximal ACL tears. Methods Thirty-seven consecutive patients undergoing ACL repair with suture tape augmentation for an acute proximal rupture were prospectively followed up for a minimum of 5 years. Patients with midsubstance and distal ruptures, poor ACL tissue quality, retracted ACL remnants and multiligament injuries were excluded. Patient-reported outcome measures were collated using the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12-Item Health Survey (VR-12) and the Marx Activity Scale. Patients with a re-rupture were identified. Results Three patients were lost to follow-up leaving 34 patients in the final analysis (91.9%). The mean KOOS at 5 years was 88.5 (SD 13.8) which improved significantly from 48.7 (SD 18.3) preoperatively (p < 0.01). The VAS score improved from 2.3 (SD 1.7) to 1.0 (SD 1.5) and the VR-12 score improved from 35.9 (SD 10.3) to 52.4 (SD 5.9) at 5 years (p < 0.01). However, the Marx activity scale decreased from 12.4 (SD 3.4) pre-injury to 7.3 (SD 5.2) at 5 years (p = 0.02). Six patients had a re-rupture (17.6%) and have since undergone a conventional ACL reconstruction for their revision surgery with no issues since then. These patients were found to be younger and have higher initial Marx activity scores than the rest of the cohort (p < 0.05). Conclusion Primary repair with suture tape augmentation for proximal ACL tears demonstrates satisfactory outcomes in 28 patients (82.4%) at 5-year follow-up. Six patients sustained a re-rupture and have no ongoing problems following treatment with a conventional ACL reconstruction. These patients were significantly younger and had higher initial Marx activity scores. Level of evidence Level IV.

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Preservation of the Anterior Cruciate Ligament: Arthroscopic Primary Repair of Proximal Tears

Cited by 8 publications

References 76 publications

Favorable Patient-Reported, Clinical, and Functional Outcomes 2 Years After ACL Repair and InternalBrace Augmentation Compared With ACL Reconstruction and Healthy Controls

Favorable Patient-Reported, Clinical, and Functional Outcomes 2 Years After ACL Repair and InternalBrace Augmentation Compared With ACL Reconstruction and Healthy Controls

Prospective Comparison of Postoperative Pain and Opioid Consumption Between Primary Repair and Reconstruction of the Anterior Cruciate Ligament

Satisfactory patient-reported outcomes at 5 years following primary repair with suture tape augmentation for proximal anterior cruciate ligament tears

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