Summary

This study demonstrates excellent patient reported outcomes and good survivorship results of ACL repair with suture tape augmentation, therefore it is an effective alternative to traditional ACL reconstructions in appropriate cases.

Abstract

An enhanced understanding of anterior cruciate ligament (ACL) healing and advancements in arthroscopic instrumentation has resulted in a renewed interest in ACL repair. The aim of this study was to assess the 2-year patient-reported outcome measures of ACL repair with suture tape augmentation in a large cohort of patients. We hypothesized that significant improvements would be seen in the patient-reported outcomes with fewer re-ruptures than those described in historic literature.

A total of 137 consecutive patients with acute ACL ruptures were prospectively followed up for a minimum of 2 years. Inclusion criteria were acute proximal tears with adequate ACL tissue quality. Patients with mid-substance, distal ACL ruptures, retracted ACL remnants and multi-ligament injuries were excluded. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Pain Scale (VAS), Veterans RAND 12 Item Health Survey (VR-12) and the Marx Activity scale were collected preoperatively and at 12 and 24 months postoperatively. Additionally, a standard questionnaire was completed 24 months postoperatively to ask patients about their overall satisfaction. Patients with any postoperative complications were identified by email/telephone at the time of this analysis. Mean follow-up was 58.7 months (range, 24-103).

Three patients were lost to follow-up and nineteen with incomplete data leaving 115 patients in the final analysis for the patient-reported outcomes (83.9%). The mean KOOS at 2 years was 89.8, 84.7, 95.5, 78.6 and 72.9 for pain, symptoms, ADL, sport/recreation and QOL respectively. These improved significantly from 60.1, 49.9, 67.1, 26.0 and 22.5 preoperatively (p<0.001). The mean WOMAC scores at 2 years were 94.2, 87.6 and 95.5 for pain, stiffness and function respectively. These improved significantly from 71.8, 57.7 and 67.1 preoperatively (p<0.001). The VAS score improved from 3.1 to 1.0 and the VR-12 score improved from 34.2 to 53.1 at 2 years (p<0.001). However, the Marx activity scale decreased from 10.6 pre-injury to 8.1 at 2 years (p<0.001). 96% of patients felt the surgery exceeded or met their expectations with regards to improving pain, movement and function and 87% of patients with regards to resuming sport. 134 patients (97.8%) were contactable regarding postoperative complications of which 22 patients suffered from a re-rupture (16.4%). All of these patients had a standard ACL reconstruction and have reported no issues. These patients were found to be significantly younger (p<0.001) and have significantly higher Marx activity scores (p<0.01).

The midterm results of ACL repair with suture tape augmentation reveal excellent outcomes in 83.6% of patients. Additionally, the patients who suffered from a re-rupture have not had any problems since their revision surgery. Based on our experience, patients who are deemed to be high risk including younger patients, those with associated Segond fractures, high levels of sporting activity and grade 3 pivot shifts, should be considered for ALL augmentation to provide additional rotational stability. In conclusion, this study demonstrates excellent patient reported outcomes and good survivorship results of ACL repair with suture tape augmentation, therefore it is an effective alternative to traditional ACL reconstructions in appropriate cases.