Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

Abstract

Purpose The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft. Methods Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (± 5 years), gender, Tegner activity scale (± 1), BMI (± 1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months. Results Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT. Conclusion At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. Level of Evidence: Level III Retrospective comparative study.

Arthroscopic Anterior Cruciate Ligament Repair Versus Autograft Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Comparative Studies

“…Two studies ( 26 , 27 ) by Murray et al focused on the same group of patients, and the study with shorter follow-up ( 27 ) was excluded. Finally, 10 articles ( 11 – 14 , 26 , 28 – 32 ) were included in the meta-analysis, including 4 RCTs ( 11 – 14 ), 1 prospective cohort study ( 26 ), 3 retrospective cohort studies ( 28 , 29 , 31 ), and 2 case–control studies ( 30 , 32 ) ( Figure 1 ).…”

“…The mean time from injury to surgery ranged from 13 to 74 days, and the follow period ranged from 12 to 36 months. Two studies ( 14 , 30 ) enrolled patients independent of the ACL rupture location, while other studies ( 11 – 13 , 26 , 28 , 29 , 31 , 32 ) mainly included patients with ACL proximal rupture. As for the selection of autograft for ACL reconstruction, most studies ( 11 – 14 , 26 , 28 , 32 ) used semitendinosus tendon, while the other studies ( 29 – 31 ) used hamstring tendon, patellar tendon, or quadriceps tendon.…”

“…Two studies ( 14 , 30 ) enrolled patients independent of the ACL rupture location, while other studies ( 11 – 13 , 26 , 28 , 29 , 31 , 32 ) mainly included patients with ACL proximal rupture. As for the selection of autograft for ACL reconstruction, most studies ( 11 – 14 , 26 , 28 , 32 ) used semitendinosus tendon, while the other studies ( 29 – 31 ) used hamstring tendon, patellar tendon, or quadriceps tendon. For the ACL repair techniques, primary SAR of the ACL was performed in 1 study ( 32 ), using one suture anchor to reattach the ACL remnant back to the femoral footprint.…”

“…A total of 2 studies ( 13 , 26 ) by Murray et al focused on patients treated with BEAR, involving suture repair of the ligament combined with a BEAR scaffold saturated with 5–10 ml autologous blood to bridge the gap between the ends of the torn ligament. In the other 3 studies ( 28 , 29 , 31 ), after completion of ACL suture repair, IBLA was achieved by adding FiberTape to the ACL substance, and fixed with a suture anchor perpendicular to the tibial cortex.…”

ACL Repair: A Game Changer or Will History Repeat Itself? A Critical Appraisal

“…These results led to the conclusion that the high risk of failure for the STA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury. Ortmaier et al matched 24 patients treated with STA with 25 hamstring and 20 quadriceps tendon reconstruction patients with a minimum follow-up of 12 months [55]. Overall, the return to sports rate was 91.3%.…”