Summary

Augmented ACLR should be considered as an alternative surgical treatment to complete ACL tears with the potential benefits of earlier improvement of pain, faster rehabilitation progress, better quality of life and increased sports and recreation function.

Abstract

Introduction

Anterior cruciate ligament is the most commonly injured knee ligament. For acute ruptures, the gold standard surgical treatment is ACL reconstruction (ACLR) using tendon or ligament autograft. Internal brace augmented ACL reconstruction is a technique that marries a previously published technique with the potential advantages of suture tape augmentation to increase the biomechanical strength of the reconstruction at the time of surgery and potentially reinforcing the graft thereafter. An internal brace is relating concept that applied knotless bone anchors and braided suture tape to fortify the strength of the ligament graft.
The main objective of the study include is to compare graft/internal brace survival, self-reported functional outcomes, and joint laxity among patients who underwent ACL hamstring tendon autograft reconstruction versus ACL repair with internal brace ligament augmentation

Methods

By blinding the exposed and control groups, the study design being applied is randomized control trial. Patients are randomly assigned into an experimental group or a control group. The control group will receive the standard practice of non-augmented hamstring autograft while the experiment group will be randomly assigned to the augmented hamstring autograft.
The study design applied is prospective, experiment, experimental level of intervention, analytical and randomized control trial.
To minimize bias and errors, all participants of the study were operated on by the same orthopedic surgeon.

Pre-op and post-op protocols were standardized between both groups, this includes rehabilitation and physical therapy programs.

Results

Ten patients (mean age 22.3 years, range 21-23) who underwent ACLR with internal brace augmentation and 27 patients (mean age 24.3 years, range 17-43) without internal brace augmentation were included in this study. No patient from both groups underwent reoperation. No patient in both groups experienced ACL failure and underwent revision ACLR. There were no statistically significant differences between the internal brace and control groups for preoperative and postoperative Tegner activity scores (6.6 to 6.2, 5.1 to 5.0), postoperative IKDC scores (71.7 and 81.2), and Lysholm scores (66.2 and 65.9). No tears were seen on follow-up MRI of all patients on both groups. 1 month post-op scores of augmented comparing to non-augmented ACLR Tegner activity scores (8.6 to 7.3, 7.1 to 7.0), Lysholm scores (76.5 and 75.8), IKDC scores (83.4 and 81.7) and KOOS scores (77 and 65) show significantly better scores amongst augmented ACLR. 4 months and 8 months scores show no statistically significant difference. 1 year post-op scores of augmented comparing to non-augmented ACLR Tegner activity scores (9.2 to 9.3, 8.1 to 8.3), Lysholm scores (96.5 and 85.8), IKDC scores (93.4 and 83.0) and KOOS scores (89 and 72) show better scores amongst patients who underwent augmented ACLR compared to non-augmented ACLR.

Discussion And Conclusion

Compared to standard hamstring ACLRs, the study showed that the population who underwent augmented hamstring ACLRs exhibited improved PROMs, less pain, and a higher percentage of and earlier return to pre-injury activity level without evidence of over constraint. Patients who underwent augmented ACLRs show significantly improved Tegner, Lysholm, KOOS and IKDC scores at 1 month and 1 year post-operative follow-ups showing better subjective outcomes.
This suggests that augmented ACLR should be considered as an alternative surgical treatment to complete ACL tears with the potential benefits of earlier improvement of pain, faster rehabilitation progress, better quality of life and increased sports and recreation function.