scholarly journals Influence of Meniscal and Chondral Lesions on Patient-Reported Outcomes After Primary Anterior Cruciate Ligament Reconstruction at 2-Year Follow-up

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711775418 ◽  
Author(s):  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Justin J. Mitchell ◽  
Gilbert Moatshe ◽  
Jonas Pogorzelski ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Chondral Lesions ◽  
Meniscal Lesions ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Mean ◽  
Anterior Cruciate

Background: Meniscal and chondral lesions are commonly associated with anterior cruciate ligament (ACL) tears, and these lesions may play a role in patient outcomes after ACL reconstruction. Purpose: To determine the effects of the presence and location of meniscal and chondral lesions at the time of ACL reconstruction on patient-reported outcomes at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with no prior knee surgery who underwent primary ACL reconstruction by a single surgeon between 2010 and 2014 were included in this study. Those meeting inclusion criteria were divided into the following groups based on the arthroscopic diagnosis: patients without concomitant meniscal or chondral lesions, patients with isolated meniscal lesions, patients with isolated chondral lesions, and patients with both chondral and meniscal lesions. Patient-reported outcomes (Short Form–12 [SF-12] physical component summary [PCS] and mental component summary [MCS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Lysholm scale) were assessed at a minimum of 2 years from the index surgery. Results: A total of 151 patients met the inclusion criteria and were included in the study. The mean age at the time of surgery was 36.2 years (range, 14-73 years), and the mean follow-up was 3.2 years (range, 2.0-5.6 years). At the time of surgery, 33 (22%) patients had no concomitant lesions and served as the control group, 63 (42%) patients had isolated meniscal lesions, 21 (14%) patients had isolated chondral lesions, and 34 (22%) patients had both chondral and meniscal lesions. There was significant improvement in all outcome scores postoperatively for the 3 groups ( P < .05 for all outcome scores). The presence of a meniscal tear and laterality of the meniscal lesion did not have a negative effect on any postoperative outcome scores. Patients with isolated chondral lesions had significantly lower postoperative WOMAC scores compared with patients without chondral lesions ( P < .05). No significant differences were found for all other scores. Patients with patellofemoral chondral lesions had significantly lower postoperative SF-12 PCS and Lysholm scores than patients with tibiofemoral chondral lesions ( P < .05). Conclusion: Patients with ACL tears achieved improved functional scores at a mean 3.2 years after ACL reconstruction. While meniscal lesions did not affect postoperative outcomes in the short term, chondral lesions were identified as a predictor for worse outcomes.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

scholarly journals Poor Associations Between Radiographic Tibiofemoral Osteoarthritis and Patient-Reported Outcomes at 16 Years After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095117
Author(s):  
Fredrik Identeg ◽  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
Kristian Samuelsson ◽  
Ninni Sernert ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade 3

Background: Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated. Purpose: To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 ± 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlbäck, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA. Results: Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of ≥2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 ± 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores ( r = –0.36 to –0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were –15.7 (95% CI, –27.5 to –4.0; P = .0093; R 2 = 0.09) for K-L grade 3 and –25.2 (95% CI, –41.7 to –8.6; P = .0033; R 2 = 0.09) for K-L grade 4. Conclusion: There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.

scholarly journals Significant Increase in the Rate of Meniscal and Chondral Injuries Between Primary and Revision Anterior Cruciate Ligament Reconstruction. (188)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Adnan Saithna ◽  
Charles Pioger ◽  
Johnny Rayes ◽  
Ibrahim Haidar ◽  
Thomas FRADIN ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Chondral Lesions ◽  
Revision Acl Reconstruction ◽  
Meniscal Lesions ◽  
The Mean ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Objectives: Anterior cruciate ligament (ACL) injuries are often associated with meniscal and chondral lesions. Meniscal lesions are present in up to 50% of ACL injured knees, and chondral lesions occur with an incidence of 20% to 40% in acute ACL-injured knees. The major importance of this lies in the fact that menisectomy and severe chondral damage are important predictors of poor outcomes including the subsequent development of knee osteoarthritis. Furthermore, patient reported outcomes following revision ACL reconstruction remain inferior to primary ACL reconstruction and this may, at least in part, be due to an increased incidence and severity of meniscal and chondral injuries. Although multiple studies have demonstrated that meniscal and chondral lesions are generally present at a higher rate at the time of revision ACL reconstruction when compared to primary ACL reconstruction, large studies following individual patients through primary and revision ACL reconstruction and tracking the change in the occurence of these injuries are scarce. The primary objective of this study was to determine the proportion of patients with meniscal and chondral injuries at the time of primary ACL reconstruction and determine how this rate changed by the time they underwent revision ACL reconstruction. The hypothesis was that the proportion of patients with meniscal and/or chondral lesions would be significantly greater at revision ACL reconstruction when compared to the primary procedures. Methods: Consecutive patients who underwent primary and then revision ACL reconstruction between March 1999 and February 2018 were identified using a single center registry. Patient characteristics, and intraoperative data from each procedure were collected and analyzed. This specifically included the occurrence and type of meniscal and chondral pathology. Descriptive statistics were used to evaluate the study sample using medians, descriptive data analysis was conducted depending on the nature of the criteria. Comparison between variables were assessed with student’s t test for quantitative variables and Mcnemar test for categorical variables. Statistical significance was set a t p<0.05. Results: 213 consecutive patients underwent both primary ACL reconstruction and then revision surgery during the study period. The average time from primary ACLR to Revision was 46.8 ± 36.6 months (range 5-181).The mean age of patients at primary ACLR was 22.21±7.21 years. The mean age of patients at revision ACLR 26.1 ± 8.3 years. The mean IKDC for the entire population was 85.53 ± 11.59, The mean ACL-RSI score was 71.89 ± 23.95. The mean Lysholm score was 91.77±10.24. The proportion of patients with chondral lesions significantly increased from 7% at primary ACL to 15.5% at revision ACL (p < 0.05). Meniscal lesions also significantly increased from 44.6 % at primary ACLR to 70% at revision ACLR (p < 0.05). There was no significant difference in the rate of lateral meniscal lesions (11.7 vs 13.1, p > 0.05). However, the proportion of patients with a medial meniscus lesion (25.4 vs 36.2, p < 0.05) and bimeniscal lesions (7.5 vs 20.7, p < 0.05) increased significantly at revision ACL reconstruction. Conclusions: The proportion of patients with meniscal and//or chondral injuries at the time of revision ACL reconstruction is significantly higher than at the time of primary ACL reconstruction. Specifically, the rate of medial meniscus and bimeniscal injuries is significantly higher in patients undergoing revision ACL reconstruction

Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review

2018 ◽  
Vol 32 (03) ◽  
pp. 218-221 ◽  
Author(s):  
Lea Johnson ◽  
Robert Brophy ◽  
Ljiljana Bogunovic ◽  
Matthew Matava ◽  
Matthew Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Level Of Evidence ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Anterior Cruciate

AbstractRevision anterior cruciate ligament (ACL) reconstruction typically has worse outcomes than primary reconstructions. Minimal long-term data exist regarding 5-year results. We chose to perform a systematic review to evaluate midterm (5-year) revision ACL reconstruction outcomes (patient-reported outcomes, reoperation, stability, arthritis) in comparison to primary ACL reconstructions at similar time points. Embase, Cochrane, and PubMed databases were queried, and four studies met the inclusion criteria. Two authors reviewed and performed data extraction. All were level 4 studies. Review of the studies demonstrated that results at 5 years are consistently worse than those noted in primary reconstructions for objective and patient-reported outcomes. Revision ACL reconstruction outcomes remain worse than primary reconstructions at midterm 5-year follow-up. The level of evidence is 4.

scholarly journals Patient-Reported Knee Outcome Scores With Soft Tissue Quadriceps Tendon Autograft Are Similar to Bone–Patellar Tendon–Bone Autograft at Minimum 2-Year Follow-up: A Retrospective Single-Center Cohort Study in Primary Anterior Cruciate Ligament Reconstruction Surgery

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989006
Author(s):  
Jose R. Perez ◽  
Christopher P. Emerson ◽  
Carlos M. Barrera ◽  
Dylan N. Greif ◽  
William H. Cade ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Patient Reported ◽  
Outcome Scores ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Bone Patellar Tendon

Background: Quadriceps tendon (QT)–bone autografts used during anterior cruciate ligament (ACL) reconstruction have provided comparable outcomes and decreased donor-site morbidity when compared with bone–patellar tendon–bone (BPTB) autografts. No study has directly compared the outcomes of the all–soft tissue QT autograft with that of the BPTB autograft. Hypothesis: Patient-reported knee outcome scores and rates of postoperative complication after primary ACL reconstruction with QT autografts are no different from BPTB autografts at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 75 patients who underwent primary autograft ACL reconstruction with QT or BPTB autografts between January 1, 2015, and March 31, 2016, at a single hospital center were contacted by telephone and asked to complete the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation, Tegner activity level scale, and Lysholm knee scoring scale. Information about the subsequent surgeries performed on the operative knee was also collected. Statistical analysis was performed using the Kruskal-Wallis test and the Fisher exact test for categorical data. Results: Fifty patients (28 QT, 22 BPTB) completed the surveys at a mean follow-up of 33.04 months (range, 24-44 months). For the QT versus the BPTB group respectively, the median IKDC scores were 94.83 (interquartile range [IQR], 7.61) versus 94.83 (IQR, 10.92) ( P = .47), the median Tegner scores were 6 (IQR, 2.5) versus 6 (IQR, 2.75) ( P = .48), and the median Lysholm scores were 95 (IQR, 9) versus 95 (IQR, 13) ( P = .27). Additionally, 2 QT patients and 3 BPTB patients required follow-up arthroscopy for arthrolysis ( P = .64). There was 1 graft failure in the QT group requiring revision surgery. Conclusion: There was no statistical difference in patient-reported knee outcomes or graft complication rates between the QT and BPTB autograft groups at a minimum 2-year follow-up after primary ACL reconstruction. This study highlights that the all–soft tissue QT autograft may be a suitable graft choice for primary ACL reconstruction.

scholarly journals Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions

2018 ◽  
Vol 46 (8) ◽  
pp. 1809-1818 ◽  
Author(s):  
Robert F. LaPrade ◽  
Mark E. Cinque ◽  
Grant J. Dornan ◽  
Nicholas N. DePhillipo ◽  
Andrew G. Geeslin ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Pcl Reconstruction ◽  
P Values ◽  
Stress Radiographs ◽  
Outcome Scores ◽  
The Mean ◽  
Anterior Cruciate

Background: Historically, outcomes of posterior cruciate ligament (PCL) reconstructions have been less predictable and reported to yield inferior results when compared with those for anterior cruciate ligament (ACL) reconstructions. Purpose: To report on the outcomes of double-bundle PCL reconstructions (DB PCLRs) in isolated versus combined injuries and acute versus chronic PCL reconstructions. To compare the outcomes of isolated DB PCLR with isolated ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent a primary endoscopic DB PCLR for complete PCL tears (grade III) between May 2010 and March 2015 were reviewed. Patient-reported outcome scores (Tegner, Lysholm, WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index], SF-12 [12-item Short Form Health Survey]) and objective posterior stress radiographs were collected preoperatively and at a minimum 2 years postoperatively. A cohort subanalysis was additionally performed between isolated and combined PCL reconstruction and acute versus chronic PCL reconstruction. Patients who underwent isolated ACL reconstructions over the same inclusion period (2010-2015) were selected as a comparison group. Results: One hundred patients who underwent DB PCLR were included in this study. There were 31 isolated PCL injuries, and 69 patients had concurrent combined PCL injuries requiring surgery. The mean follow-up for the PCL cohort was 2.9 years (range, 2-6 years). The median Tegner activity score improved from 2 to 5, Lysholm from 48 to 86, WOMAC from 35.5 to 5, and SF-12 Physical Component Summary from 34 to 54.8 (all P values <.001). The mean side-to-side difference in posterior tibial translation on kneeling stress radiographs improved from 11.0 ± 3.5 mm preoperatively to 1.6 ± 2.0 mm postoperatively ( P < .001). There were no differences in postoperative functional scores between isolated PCL reconstructions and PCL-based multiligament reconstructions (all P values >.229). There was no significant difference in the reported outcome scores between acute and chronic reconstructions (all P values >.087) except for Tegner scores ( P < .001) and patient satisfaction ( P = .011) favoring acutely treated PCL injuries. There were no significant differences between patients who had an isolated DB PCLR and patients who underwent an isolated ACL reconstruction (n = 141) in postoperative outcome scores (all P values >.064). Conclusion: Significantly improved functional and objective outcomes were observed after anatomic DB PCLR at a mean 3 years’ follow-up, with low complication rates, regardless of concomitant ligamentous injury or timing to surgery. Additionally, contrary to previous reports, comparable subjective and functional clinical outcomes were achieved compared with an isolated ACL reconstruction control cohort.

Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-Analysis Comparing Semitendinosus Alone and Semitendinosus with Gracilis Tendon Autografts

2018 ◽  
Vol 32 (08) ◽  
pp. 796-803
Author(s):  
Brian Zhaojie Chin ◽  
Ian Jun Yan Wee ◽  
Nicholas Li-Xun Syn ◽  
Lingaraj Krishna
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Peak Torque ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Anterior Laxity ◽  
Anterior Cruciate

AbstractThe objective of this study was to provide a comprehensive systematic review and meta-analysis to compare patient-reported outcomes and functional knee parameters of anterior cruciate ligament (ACL) reconstruction surgery with semitendinosus (ST) and ST-gracilis (G) grafts. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. All studies in PubMed and Embase that reported functional knee parameters and patient-reported outcomes after ACL reconstruction with ST and ST-G grafts independently were included in the review. Selected end points for random effects, pairwise meta-analysis included side-to-side deficit (%) in isokinetic peak torque, peak torque ratio (%), side-to-side difference (mm) in anterior laxity, and patient-reported outcome scores at minimum 2-year follow-up. A total of 15 primary references comprising 1,109 participants were identified. The ST group had decreased side-to-side deficit in isokinetic peak torque when compared with the ST-G group for flexion at 60 degrees/s (p = 0.02) and 180 degrees/s (p = 0.01) at 2-year follow-up. There were no significant differences in side-to-side difference in anterior laxity (p = 0.81), hamstring/quadriceps peak torque ratios at 60 degrees/s (p = 0.83) and 180 degrees/s (p = 0.36), and patient-reported outcomes in the International Knee Documentation Committee score (p = 0.06) and Lysholm score (p = 0.67). The addition of the gracilis tendon to the hamstring autograft in ACL reconstruction results in increased side-to-side deficits in isokinetic peak flexion torque. However, patient-reported outcome scores and knee laxity measurements are comparable with those of ST grafts.

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

2021 ◽  
Author(s):  
Graeme P. Hopper ◽  
Joanna M. S. Aithie ◽  
Joanne M. Jenkins ◽  
William T. Wilson ◽  
Gordon M. Mackay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Acl Repair ◽  
Patient Reported ◽  
Activity Scale ◽  
Anterior Cruciate ◽  
Suture Tape

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.

scholarly journals Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears: With or Without Additional Suture Augmentation?

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006 ◽  
Author(s):  
Anne Jonkergouw ◽  
Jelle P. van der List ◽  
Gregory S. DiFelice
Keyword(s):  
Range Of Motion ◽  
Patient Reported Outcomes ◽  
Suture Anchor ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Type I ◽  
Acl Repair ◽  
Patient Reported ◽  
Anterior Cruciate

Objectives: Over the last years, arthroscopic primary repair of anterior cruciate ligament (ACL) tears has shown excellent results owing to appropriate patient selection (only repairing proximal ACL tears and good tissue quality), minimal invasive surgery (arthroscopy) and focus on early range of motion. Some surgeons have repaired proximal ACL tears without suture augmentation while others have used internal suture augmentation to reinforce and thus protect the repaired ligament during range of motion. No studies have yet compared the two surgical techniques. The objective of this study was to compare failure rates, reoperation rates and patient-reported outcomes of arthroscopic primary repair with versus without suture augmentation. Methods: A retrospective search for all patients treated with suture anchor arthroscopic primary ACL repair between April 2008 and June 2016 was performed. All patients with isolated proximal ACL tears (type I) were included. Since the development of internal suture augmentation, this reinforcement was added to the repaired ACLs. Minimum follow-up length was 1.0 years. Results: A total of 56 patients were included (mean age 33 years (range: 14 - 57), 59% male) of which 28 (50%) patients received additional suture augmentation. Mean follow-up was 2.3 years (range: 1.0-9.2). Six of all patients had reruptured their repaired ACL (10.7%), of which four underwent uncomplicated ACL reconstruction and two were treated conservatively. Four reruptures were initially treated with primary repair only (4/28, 14.3%) and two patients with additional suture augmentation (2/28, 7.1%; p = 0.431). During follow-up, three patients underwent reoperation (5.4%; two for medial meniscus tear (one in each group) and one for tibial suture anchor removal of the suture augmentation). Patient-reported outcomes have so far been collected in 20 patients without reruptures (currently collecting), with mean Lysholm score of 96, modified Cincinnati 94, SANE 93, pre-injury Tegner 6.7, postoperative Tegner 6.3 and subjective IKDC 91. Objective IKDC was A in 90%, B in 5%, C in 5%. Conclusion: In this study, the total failure rate of arthroscopic primary ACL repair was 10.7% and was lower with additional suture augmentation (7.1%) than primary repair alone (14.3%). Patients with failed ACL repair underwent uncomplicated primary ACL reconstruction. We recommend adding suture augmentation in high-risk patients (i.e. adolescents, ones with hyperlaxity, high contact sports), to protect the repaired ligament, especially during early range of motion. These data support treating type I proximal ACL tears with arthroscopic primary repair.

Sign in / Sign up

Export Citation Format

Share Document