The addition of an internal brace to the graft construct in ACL reconstruction is a recently evolving surgical technique, with the hope of reducing reinjury and improving outcomes. To date there is limited literature on this technique, particularly examining the effect this addition may have on graft healing or clinical outcomes.
To determine the influence of an internal brace on the healing of a primary single bundle ACL graft at 1-year
A case-matched series was used to compare graft healing, as assessed by high resolution MRI scan at 12 months, in 2 cohorts of ACL reconstruction patients. A single surgeon case series of 68 patients who underwent hamstring ACL reconstruction with bipolar suspensory fixation and the addition of an internal brace to the construct were compared against an age and sex matched cohort of ACL reconstructions from the same surgeon using the identical technique but without the internal brace. MRI scans at one-year post-operatively were analysed using a previously validated protocol to assess the graft signal/noise quotient (SNQ) across three sites of the graft, as a measure of graft healing after primary single-bundle ACL reconstruction
There was no effect of age or gender on SNQ (p>0.05). The SNQ values in the internal brace group were distally 2.1 ± 2.6, midsubstance 4.1 ± 3.7, proximally 3.3 ± 2.9, with a mean SNQ of 3.2 ± 2.6. The SNQ values in the cohort without the internal brace was distally 2.1 ± 1.9, in the midsubstance 3.1 ± 2.0, proximally 2.3 ± 1.4, with an overall mean of 2.5 ±1.5. There was no significant difference (p>0.05) in SNQ between the ACL reconstruction group using internal brace and the group without the use of an internal brace at any of the 3 measurement areas or between the means, although the p value in the proximal measurement approached significance at 0.051. There was no significant difference between Tegner, IKDC and Lysholm scores recorded at 12 months between the cohorts. KT-1000 measurements at 134N also showed no significant difference between the cohorts.
The use of an internal brace in a single-bundle hamstring ACL reconstruction does not appear to affect graft healing, as assessed by MRI scan at 1 year.