Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients

Abstract

Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1–25.1) and a mean follow-up of 37.9 months (95% CI: 35.8–40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2–92.9] vs. 82.6 [95% CI: 79.0–86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5–0.8] vs. 1.2 [95% CI: 0.8–1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. Level of Evidence: case series, IV

Quadriceps Tendon Autograft ACL Reconstruction With Suture Tape Augmentation: Safe Results Based on Minimum 2-Year Follow-up MRI

“…7,37,39 Regarding the MCID and PASS thresholds for VAS pain, an MCID of 1.2 points and a PASS of 1 were applied. 13…”

“…41 Previously reported values for the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were applied to all applicable PROMs for the final PROM interpretation. 7,13,37,39 For the Lysholm score, an MCID of 10.6 points was applied. 39 For the IKDC, an MCID of 18.9 points and a PASS of 75.9 were applied.…”

“…7,37,39 Regarding the MCID and PASS thresholds for VAS pain, an MCID of 1.2 points and a PASS of 1 were applied. 13 At the 2-year prospective follow-up, each patient underwent a physical examination, which included anterior laxity testing using a KT-1000 arthrometer (MEDmetric) and radiographic imaging. A prospective MRI of the ipsilateral knee was collected at least 1 year postoperatively.…”

“…Recently, there has been renewed interest in graftaugmentation techniques for ACLR, 13,26,28,34,40,[48][49][50][51][52] especially relating to the biomechanical benefit of graft protection and load sharing. 5,6,26,34 In 2 separate biomechanical studies performed by Bachmaier et al, 5,6 it was found that independent suture tape augmentation (STA) led to significantly reduced graft elongation, higher ultimate failure loads without signs of stress shielding, and increased final construct stiffness.…”