The Addition of Suture Tape to the Hamstring Graft Construct Does Not Reduce Instrumented Knee Laxity Following ACL Reconstruction

Abstract

Purpose: To establish the effect of the addition of suture tape to the hamstring graft construct through measurement of instrumented sagittal plane knee laxity at 6 months after anterior cruciate ligament reconstruction (ACLR). Methods: A retrospective analysis was undertaken of a consecutive series of primary ACLR performed between May 2017 and June 2019. Patients with concomitant or historic contralateral knee injury were excluded. Suture tape was included in the graft construct from the midpoint of the study period (May 2018). Sagittal plane knee laxity was quantified using the KT2000 arthrometer at 6 postoperative months. Mean side-to-side differences in sagittal plane laxity between the operated and contralateral, uninjured knees were compared for grafts with and without suture tape. Additional outcomes included comparison between suture tape application techniques (graft reinforcement versus augmentation), comparison between suture tape with and without iliotibial band (ITB) tenodesis and documentation of complications necessitating further surgery. Results: A total of 169 patients were eligible for inclusion. Seventy-two grafts included suture tape and 84 patients underwent concomitant ITB tenodesis. There was no significant difference in mean laxity between grafts containing suture tape (mean difference: 1.2 mm, SD: 2.6 mm) and those without (mean difference: 1.3 mm, SD: 2.1 mm), P ¼ .83 (CI À.92 to 1.13). Neither were there significant differences in laxity when using suture tape with concomitant ITB tenodesis (mean difference: 1.1 mm, SD: 2.1 mm), P ¼ .75 (CI À.79 to 1.09), or when comparing techniques: graft reinforcement (mean difference .9 mm, SD 2.6 mm); graft augmentation (mean difference: 1.5 mm, SD: 2.5 mm) P ¼ .52 (CI À2.29 to 1.16). There were no complications associated with suture tape. Conclusions: The addition of suture tape to an autologous hamstring graft construct did not reduce instrumented sagittal knee laxity in the first 6 months after ACL reconstruction. As such, the clinical relevance of its use remains unknown.

Suture tape augmentation, a novel application of synthetic materials in anterior cruciate ligament reconstruction: A systematic review

“…Critical application of the inclusion and exclusion criteria finally yielded nine studies ( Figure 2 ). One was a prospective cohort study (level 2) ( Shantanu et al, 2019 ), six were retrospective cohort studies (level 3) ( Bodendorfer et al, 2019 ; Parkes et al, 2021 ; Allom et al, 2022 ; Kitchen et al, 2022 ; Szakiel et al, 2022 ; von Essen et al, 2022 ), and two were case series (level 4) ( Lavender et al, 2021 ; Duong et al, 2022 ). All seven comparative studies were designed to compare patients who underwent ACLR with and without ST-augmented grafts ( Table 2 ).…”

“…For all studies, the use of ST was based on the surgeon’s preference, except for one prospective cohort study with randomized selection. Concomitant lateral extra-articular tenodesis was performed in one study ( Allom et al, 2022 ) for 84/169 patients with risk factors for graft rupture.…”

“…Overall, eight subjective scores were reported in eight out of nine studies: the Lysholm score in four studies, International Knee Documentation Committee (IKDC) score in three studies, Knee injury and Osteoarthritis Outcome Score (KOOS) score in three studies, Single Assessment Numeric Evaluation (SANE) score in two studies, Tegner activity score in two studies, visual analogue scale (VAS) score in two studies, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score in one study, and IKDC grade in one study. The remaining one study ( Allom et al, 2022 ) not reporting any subjective score ( Table 2 ).…”

“…Overall, eight subjective scores were reported in eight out of nine studies: the Lysholm score in four studies, International Knee Documentation Committee (IKDC) score in three studies, (Allom et al, 2022) not reporting any subjective score (Table 2).…”

There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta‐analysis

“…Much of the research focuses on determining the best graft choice for these patients. Previous studies reported that suture tape augmentation of ACLR increases biomechanical stability and reduces complications [1, 8, 25]. Although the benefits of this solution are theoretically appealing, its clinical advantages still need to be clarified.…”