Repair With Dynamic Intraligamentary Stabilization Versus Primary Reconstruction of Acute Anterior Cruciate Ligament Tears: 2-Year Results From a Prospective Randomized Study

Abstract

Background: Anterior cruciate ligament (ACL) repair has once again become a focus of research because of the development of new techniques. Purpose/Hypothesis: The purpose was to compare the functional results and recurrent instability rates in patients undergoing ACL repair with dynamic intraligamentary stabilization (DIS) versus primary ACL reconstruction (ACLR) for acute isolated ACL tears. The hypothesis was that functional results and knee joint stability after ACL repair with DIS would be comparable with that after ACLR. Study Design: Randomized clinical trial; Level of evidence, 1. Methods: A total of 85 patients with acute ACL tears were randomized to undergo either ACL repair with DIS or primary ACLR. The preinjury activity level and function were recorded. Follow-up examinations were performed at 6 weeks and 6, 12, and 24 months postoperatively. Anterior tibial translation (ATT) was evaluated using Rolimeter testing. The Tegner activity scale, International Knee Documentation Committee (IKDC) subjective form, and Lysholm knee scoring scale scores were obtained. Clinical failure was defined as ΔATT >3 mm in combination with subjective instability. Recurrent instability and other complications were recorded. Results: There were 83 patients (97.6%) who were successfully followed until 2 years. ATT was significantly increased in the DIS group compared with the ACLR group (ΔATT, 1.9 vs 0.9 mm, respectively; P = .0086). A total of 7 patients (16.3%) in the DIS group had clinical failure and underwent single-stage revision. In the ACLR group, 5 patients (12.5%) had failure of the reconstruction procedure; 4 of these patients required 2-stage revision. The difference in the failure rate was not significant ( P = .432). There were 4 patients (3 in the DIS group and 1 in the ACLR group) who showed increased laxity (ΔATT >3 mm) without subjective instability and did not require revision. Recurrent instability was associated with young age (<25 years) and high Tegner scores (>6) in both groups. No significant differences between ACL repair with DIS and ACLR were found for the Tegner, IKDC, and Lysholm scores at any time. Conclusion: Whereas ATT measured by Rolimeter testing was significantly increased after ACL repair with DIS, clinical failure was similar to that after ACLR. In addition, functional results after ACL repair with DIS for acute tears were comparable with those after ACLR. The current study supports the use of ACL repair with DIS as an option to treat acute ACL tears. Registration: DRKS00015466 (German Clinical Trials Register)

Good to Excellent Functional Short-Term Outcome and Low Revision Rates Following Primary Anterior Cruciate Ligament Repair Using Suture Augmentation

“…The arthroscopic ACL repair technique with the most experimental and clinical data available is DIS [ 32 , 33 , 34 , 35 , 36 ]. Although several authors reported functional results comparable to our cohort, Ahmad et al reported low DIS survival rates (of only 70% at 5-year follow-up) and Osti et al reported a high rate of recurrent instability (of up to 17.5%) [ 22 , 32 , 35 , 37 , 38 ]. While Ahmad et al concluded that they were lacking evidence of the ideal surgical candidate during patient enrolment and stricter indications would have likely resulted in an overall better outcome, first randomized clinical trials show that functional results and clinical failure of DIS are comparable to ACL reconstruction [ 37 , 38 ].…”

“…Although several authors reported functional results comparable to our cohort, Ahmad et al reported low DIS survival rates (of only 70% at 5-year follow-up) and Osti et al reported a high rate of recurrent instability (of up to 17.5%) [ 22 , 32 , 35 , 37 , 38 ]. While Ahmad et al concluded that they were lacking evidence of the ideal surgical candidate during patient enrolment and stricter indications would have likely resulted in an overall better outcome, first randomized clinical trials show that functional results and clinical failure of DIS are comparable to ACL reconstruction [ 37 , 38 ]. Although the understanding of the ideal surgical candidate for ACL repair has evolved over the past few years and critical patient selection was routinely performed in the reported cohorts, no randomized controlled trial comparing SA and ACL reconstruction has yet been performed [ 10 , 35 ].…”

Knotless Primary Anterior Cruciate Ligament Repair with Adjustable Loop Device and Internal Brace Augmentation

“…compared primary ACL repair with DIS to primary ACL reconstruction and found significantly increased anterior tibial translation (ATT) in the DIS group but similar failure rates between the two groups. 23 …”

Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction With a Single-Strand Gracilis Graft

“…Despite better patient selection and advances in repair techniques, the risk of failure after isolated suture repair of the ACL remains a concern. 8 Intra-articular augmentation has been proposed to protect the repair during the healing period. 6,9 The originality of the technique described here consists of the use of a single-strand gracilis graft as a "biological" internal brace for intra-articular augmentation of the repair and as an anterolateral graft to protect the repair during the healing phase.…”