Reduced Incidence of Revision Anterior Cruciate Ligament Reconstruction With Internal Brace Augmentation

Abstract

Background: Revision rates and outcome measures after anterior cruciate ligament reconstruction (ACLR) with suture tape as an internal brace is not well-documented because of the emerging nature of the technique. Hypothesis: ACLR with internal bracing (IB) would lead to decreased revision ACLR compared with traditional ACLR while exhibiting comparable patient outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 200 patients were included in this study. Patients aged between 13 and 39 years at the time of surgery who underwent primary autograft ACLR with IB between 2010 and 2020 and were enrolled in our institution’s registry with a minimum of 2-year follow-up were identified and matched 1 to 1 with a non-internal brace (no-IB) group based on concomitant procedures and patient characteristics. Pre- and postoperatively, patients completed the Knee injury and Osteoarthritis Outcome Score, Marx activity rating scale, Veterans RAND 12-Item Health Survey, and visual analog scale for pain. Knee laxity measurements via the KT-1000 arthrometer were included in the pre- and postoperative objective clinical assessments. Results: A total of 100 IB patients were matched with 100 no-IB patients based primarily on concomitant procedures and secondarily on patient characteristics. The IB group underwent significantly fewer revision ACLRs (1% vs 8%; P = .017). Even though the no-IB group had a significantly longer mean final follow-up time (48.6 months [95% CI, 45.4-51.7] vs 33.4 months [95% CI, 30.3-36.5]; P < .001), the time elapsed from the original ACLR to the revision did not differ significantly between groups, and the mean ages for the IB and no-IB groups were comparable (19 vs 19.9 years). All postoperative patient-reported outcome scores between the 2 groups were comparable and significantly improved postoperatively except for the Marx score, which significantly decreased stepwise for both groups postoperatively. KT-1000 measurements significantly improved in both groups after surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97 vs 0.65 mm). Conclusion: ACLR with IB resulted in a significantly decreased risk of revision ACLRs while maintaining comparable patient-reported outcomes. Therefore, incorporating an internal brace into ACLR appears to be safe and effective within these study parameters.

Advancements in Anterior Cruciate Ligament Repair—Current State of the Art

“…The literature agrees that specific rehabilitation protocols after ACL repair are lacking and are usually extrapolated by ACL-R [1][2][3][4][5][6]. However, as reported by Duong et al [14] and by Robertson et al [1], without graft harvest comorbidity, a faster and less painful recovery is expected, with quicker patient confidence in mobility.…”

“…Anterior cruciate ligament (ACL) treatment is one of the hottest topics in the orthopedic field and is continuously evolving [1,2]. Recent epidemiological studies have highlighted ACL tears as among the most prevalent knee injuries, with an estimated annual incidence ranging from 100,000 to 200,000 cases in the United States alone [3][4][5]. Moreover, ACL tears disproportionately affect athletes participating in high-risk sports such as soccer, basketball, and football, contributing significantly to morbidity and imposing a substantial economic burden [4,6].…”

“…Patients often present with a history of a sudden twisting or pivoting motion, followed by a popping sensation in the knee joint, swelling, and instability. Physical examination may reveal findings such as a positive Lachman test, anterior drawer test, or pivot shift test, indicating ligament laxity and instability [3,4,6]. Diagnostic imaging, including magnetic resonance imaging (MRI), is commonly used to confirm the diagnosis, visualize the extent of the injury, and assess for associated damage to other structures within the knee joint, such as meniscal tears or cartilage injuries [6][7][8].…”

An Update on Emerging Techniques and Considerations in Revision Anterior Cruciate Ligament Reconstruction

“…The knee is then cycled vigorously, final graft tensioning is performed, and final graft fixation to the tibia is performed. In performing fixation in this manner, the surgeon ensures shared loading between the graft and suture tapes while simultaneously protecting the graft from excessive loads 103,104 .…”

“…Biomechanical studies support the efficacy of graft augmentation, showing increased tensile strength and reduced elongation of the graft, which may be particularly beneficial for small-diameter grafts 102,105 . Although clinical evidence remains limited to primary ACLR, early results suggest improvements in PROM, reduced pain, and a quicker RTS which underscores the potential of suture tape augmentation in ACLR to support more rapid and successful rehabilitation for patients aiming to return to preinjury levels of activity 103,104 .…”