Summary

Building on newly published evidence, this study is the first to have conducted a data synthesis to compare the clinical outcome between suture augmentation (SA)- and standard ACLR. It was found that SA-ACLR was associated with reduced graft failure rate, increased RTS rate, and comparable PROMs compared with standard ACLR without increasing reoperation and complication rates.

Abstract

Purpose

To compare graft failure, non-revision reoperation, complication, patient-reported outcome measures (PROMs), and return to sports (RTS) between patients who underwent anterior cruciate ligament reconstruction (ACLR) with versus without suture augmentation (SA).

Methods

A systematic search was performed on PubMed, Cochrane, Embase, and Web of Science databases from the inception of databases to April 18, 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing clinical outcomes of SA- and standard ACLR with a minimum 2-year follow-up were included. Data extraction and quality appraisal were performed by 2 researchers independently.

Results

Eight retrospective cohort studies were included, with a total of 408 patients receiving SA-ACLR and 443 patients receiving standard ACLR. A meta-analysis of graft failure demonstrated a 62% relative risk reduction (RR [risk ratio], 0.38 [95% CI, 0.19 to 0.73]; P = .004) in those receiving SA-ACLR compared with standard ACLR. An age-related heterogeneity in graft failure reduction was detected in the subgroup analysis, which was more pronounced in studies with mean ages of <20 years compared with ≥20 years (P = .05; I2 = 73.9%). No significant difference was observed in non-revision reoperation or complication rates. No clinically relevant difference was observed in PROMs. SA-ACLR was associated with a significantly higher RTS rate compared with the standard ACLR (RR, 1.12 [95% CI, 1.00 to 1.24]; P = .04), whereas no significant difference was observed in time to RTS.

Conclusion

SA-ACLR is associated with a reduced graft failure rate, increased RTS rate, and comparable PROMs compared with standard ACLR without increasing reoperation and complication rates. However, confidence in the evidence is limited by substantial heterogeneity. Future studies with a higher level of evidence are warranted to validate the benefit of SA and to determine the indication for different risk populations.