Summary

Despite a longer and technically more difficult procedure, an augmentation technique for ACL reconstructions using a hamstring and reinsertion of residual fibers did not improve functional outcomes or decrease complication rates.

Abstract

Introduction

Complication rates after ACL reconstruction remain important despite the evolution of techniques. Isolated ACL repairs did not provide improvement and techniques with augmentation have therefore been described. Our hypothesis was that an increase of the graft by reinsertion of the residual ACL fibers of the remnant associated with the graft would improve the results.

Method

We carried out a prospective continuous series of 68 patients who underwent augmentation (AS) with a hamstring and reinsertion of the ACL fibers of the remnant. The technique consisted of a reconstruction of the ACL type ST4 with fixation by 2 adjustable endo-buttons and reinsertion of the residual fibers with passage of the reinsertion wires in the femoral fixation. This series was compared to a control series (CS) of 71 patients with classic ACL reconstruction and hamstring graft. The inclusion criteria were a technique with ACL augmentation, no additional procedure such as lateral tenodesis/Anterolateral Ligament and a minimum of 2 years of follow-up. Rates of re-rupture, reoperation and postoperative subjective scores (SKV, IKDC, ACL-RSI) were evaluated.

Results

The 2 groups were comparable preoperatively for all parameters studied (sex, age, BMI, meniscal lesions). At a mean follow-up of 3 years, in AS, 4 patients were excluded because they were lost to follow-up and 6 patients (9%) had a re-rupture of the ACL. We did not find any significant difference regarding the re-rupture rate: 6/64 ±1.9 (AS) vs 2/71 ±2.5 (SC), p =0.7), the reoperation rate (3/64 ±1.9 (AS) vs 4/71 ±2.1 (SC), p=0.9) or functional scores: SKV = 84.4 ±18.1 (AS) vs 88.8 ±10.6 (SC) (p=0.2), IKDC = 85.4 ± 12.8 (AS) vs 87.8 9.8 (SC) (p = 0.6), ACL-RSI = 68 .4 ±25.5 (AS) vs. 71.1 22.1 (SC) (p = 0.7).

Conclusion

An augmentation technique for ACL reconstructions with reinsertion of residual fibers of the remnant of the ACL did not improve functional outcomes or decrease complication rates despite a longer and technically more difficult procedure. Our results may be linked to insufficient follow-up or numbers of patients, but these were 2 comparable series with follow-up longer than 2 years.