Summary

Suture tape augmentation of autograft ACL reconstruction for both hamstring and patellar tendon grafts is a successful technique with a failure rate of 1.1% at mean 5 years

Abstract

Reconstruction using autograft remains the standard treatment for anterior cruciate ligament (ACL) injuries. Following ACL reconstruction approximately 10% of patients have a graft rupture with the highest risk when returning to sport within the first year. Incorporation of suture tape into the autologous graft has been suggested as an option to protect the graft from early re-rupture and enable early rehabilitation.
In this study we report the clinical outcomes of patients who underwent ACL reconstruction with suture tape augmentation at a mean follow-up of five years postoperatively.

Patients undergoing primary ACL reconstruction using either hamstring or patellar tendon autograft were recruited prospectively. All patients had autograft augmented with high-strength suture tape. Patients who had a lateral extra-articular procedure were excluded. Follow up was clinically for 6 months and then remotely to collect PROMS to 5 years postoperatively (minimum 2 years). All patients were contacted and records reviewed to determine incidence of graft failure. PROMs collected were KOOS, VR-12, Tegner and Marx activity scores and Visual analogue scale for pain (VAS).


A total of 97 patients were included, comprising 52 hamstring (doubled/tripled semitendinosus) and 45 bone-patella tendon-bone grafts. There were 7 patients lost to follow up, giving a follow up rate of 93%. The average age was 33 years (14 – 62) and Tegner score pre-injury was 7 (3 – 10), with 76% of patients being male. The mean graft diameter was 8mm (±1). The mean follow up duration was 5 years (3.4 – 7.3).
There was a single re-rupture (rate 1.1%) at mean 5 years postoperatively. There was a decrease in Tegner score overall from pre-injury (7) to current (6) and a decrease in Marx activity score from 12 pre-injury to 9 at 2 years for hamstring, however no significant decrease was seen for patellar tendon. Median KOOS scores at 2 years were Pain 94, Symptoms 86, ADL 99, Sport 82, QOL 81. These were significantly higher than the respective scores preoperatively (p<0.001). VR-12 Physical score improved from 43 preoperatively to 55 at 2 years and remains 56 at 5 years. VAS pain score improved from mean 2 preoperatively to 0 at 2 years post-op. There was no difference in PROM scores between graft types.

The failure rate of 1% at mean 5 years postoperatively is lower than the published rates for ACL reconstruction (6-16%). This is an encouraging finding and supports the laboratory studies showing the construct to be biomechanically stronger. Despite the graft diameter being smaller than recommended, there was no increase in failure rate, validating biomechanical findings that suture tape has the greatest effect augmenting smaller diameter grafts.
In conclusion, this study demonstrates encouraging results of suture tape augmentation of autograft ACL reconstruction for both hamstring and patellar tendon grafts. The failure rate of 1.1% at mean 5 years is lower than the published rates for reconstruction and PROMs are satisfactory. The technique is safe to use in appropriate cases and may improve ability to return to preinjury sporting level with a lower chance of reinjury.