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

Abstract

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.

Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Five-Year Results of a Randomized Controlled Clinical Trial

“…11,14,31,38,48,50 Recently, patient selection criteria for contemporary ACLSR have been proposed, and younger age (which may be a proxy for activities that are strenuous on the knee), (pursuit of) higher activity level, midsubstance ACL rupture location, lack of integrity of the ruptured ACL tissue and synovial sheath, and prolonged time from injury to surgery have been reported to negatively influence the outcomes of contemporary ACLSR techniques. 2,12,21,27,35,51,54 Except for timely operative treatment, none of the above factors were considered when including patients in the present study; included patients were young and athletically active, their inclusion was independent of ACL rupture location (although most patients had a proximal ACL rupture with <50% retraction of the synovial sheath), and the majority had a multilacerated tibial ACL remnant. 23 Thus, this might have negatively influenced the results for DA ACLSR in the present study.…”

“…Some retrospective case series on nonaugmented and static augmented ACLSR have reported outcomes comparable with those reported in the present study. 7,22,27 Furthermore, in a prospective pilot study of 10 patients after DA ACLSR, Eggli et al 9 reported a median IKDCs of 98.9 with a range of 79.3 to 100 at the 5–year follow–up. In a prospective case series of 57 patients after DA ACLSR, Ahmad et al 1 reported a median IKDCs of 94.0 with a range of 63.2 to 100.0 at the 6–year mean follow–up.…”

All-inside arthroscopic anterior cruciate ligament reconstruction with internal brace Ligament Augmentation using semitendinosus tendon autograft: A case series

“… 17 Moreover, cases of re-rupture and other postoperative complications were still apparent. 17 , 18 , 19 Based on that account, more studies should be performed, not just only on ACL repair, but also ACL reconstruction and the benefits of internal suture tape for these techniques. After this case series, a randomized controlled study with a larger sample size should be performed, on patients undergoing ACL reconstruction with and without suture tape, with a long-term follow-up period, in order to precisely identify the overall benefits of suture augmentation to patients' subjective and objective outcomes.…”

Comparable rates of secondary surgery between anterior cruciate ligament repair with suture tape augmentation and anterior cruciate ligament reconstruction

“…Furthermore, Douoguih et al revealed a 14.8% re-rupture rate in their study of 27 patients with minimum 2-year follow-up and a similar study showed a rate of 6.9% in 29 patients [ 1 , 3 ]. Recently, a five-year follow-up prospective evaluation revealed a 17.6% re-rupture rate and they found those patients to be younger and have significantly higher activity levels than the rest of the cohort [ 9 ]. They also published a further study which revealed that those high-risk patients benefit from an additional ALL procedure, however, this was at short-term follow-up [ 8 ].…”