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DOI: 10.1055/a-2129-8893
Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients
Funding None.![](https://www.thieme-connect.de/media/jks/202405/lookinside/thumbnails/10-1055-a-2129-8893_22nov0153oa-1.jpg)
Abstract
Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1–25.1) and a mean follow-up of 37.9 months (95% CI: 35.8–40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2–92.9] vs. 82.6 [95% CI: 79.0–86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5–0.8] vs. 1.2 [95% CI: 0.8–1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%.
Level of Evidence: case series, IV
Publication History
Received: 11 November 2022
Accepted: 13 July 2023
Accepted Manuscript online:
14 July 2023
Article published online:
10 August 2023
© 2023. Thieme. All rights reserved.
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References
- 1 Evans J, Nielson Jl. Anterior Cruciate Ligament Knee Injuries. Treasure Island, FL: StatPearls Publishing; 2022
- 2 Gans I, Retzky JS, Jones LC, Tanaka MJ. Epidemiology of recurrent anterior cruciate ligament injuries in National Collegiate Athletic Association Sports: the Injury Surveillance Program, 2004-2014. Orthop J Sports Med 2018; 6 (06) 23 25967118777823
- 3 Gornitzky AL, Lott A, Yellin JL, Fabricant PD, Lawrence JT, Ganley TJ. Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high school athletes: a systematic review and meta-analysis. Am J Sports Med 2016; 44 (10) 2716-2723
- 4 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
- 5 Sanders TL, Maradit Kremers H, Bryan AJ. et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 2016; 44 (06) 1502-1507
- 6 Raines BT, Naclerio E, Sherman SL. Management of anterior cruciate ligament injury: what's in and what's out?. Indian J Orthop 2017; 51 (05) 563-575
- 7 Kamath GV, Murphy T, Creighton RA, Viradia N, Taft TN, Spang JT. Anterior cruciate ligament injury, return to play, and reinjury in the elite collegiate athlete: analysis of an NCAA Division I cohort. Am J Sports Med 2014; 42 (07) 1638-1643
- 8 Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 2012; 40 (07) 1551-1557
- 9 Webster KE, Feller JA. Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 2016; 44 (11) 2827-2832
- 10 Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 2016; 44 (07) 1861-1876
- 11 Engler ID, Salzler MJ, Wall AJ. et al. Patient-reported outcomes after multiple-revision ACL reconstruction: good but not great. Arthrosc Sports Med Rehabil 2020; 2 (05) e539-e546
- 12 MARS Group. Meniscal and articular cartilage predictors of clinical outcome after revision anterior cruciate ligament reconstruction. Am J Sports Med 2016; 44 (07) 1671-1679
- 13 Marx JS, Plantz MA, Gerlach EB. et al. Revision ACL reconstruction has higher incidence of 30-day hospital readmission, reoperation, and surgical complications relative to primary procedures. Knee Surg Sports Traumatol Arthrosc 2022; 30 (05) 1605-1610
- 14 Anderson SR, Youssefzadeh KA, Limpisvasti O. Anterior cruciate ligament reconstruction with suture tape augmentation: a surgical technique. Arthrosc Tech 2019; 8 (12) e1579-e1582
- 15 E A Mackenzie C, Huntington LS, Tulloch S. Suture tape augmentation of anterior cruciate ligament reconstruction increases biomechanical stability: a scoping review of biomechanical, animal, and clinical studies. Arthroscopy 2022; 38 (06) 2073-2089
- 16 Saper MG. Quadriceps tendon autograft anterior cruciate ligament reconstruction with independent suture tape reinforcement. Arthrosc Tech 2018; 7 (11) e1221-e1229
- 17 Smith PA. Editorial commentary: anterior cruciate ligament graft reinforcement: a new era supported by science. Arthroscopy 2019; 35 (07) 2123-2126
- 18 Smith PA, Bley JA. Allograft anterior cruciate ligament reconstruction utilizing internal brace augmentation. Arthrosc Tech 2016; 5 (05) e1143-e1147
- 19 Smith PA, Bozynski CC, Kuroki K, Henrich SM, Wijdicks CA, Cook JL. Intra-articular biocompatibility of multistranded, long-chain polyethylene suture tape in a canine ACL model. J Knee Surg 2019; 32 (06) 525-531
- 20 Smith PA, Bradley JP, Konicek J, Bley JA, Wijdicks CA. Independent suture tape internal brace reinforcement of bone-patellar tendon-bone allografts: biomechanical assessment in a full-ACL reconstruction laboratory model. J Knee Surg 2020; 33 (10) 1047-1054
- 21 Bachmaier S, Smith PA, Argintar EH, Chahla J, Higgins LD, Wijdicks CA. Independent suture augmentation with all-inside anterior cruciate ligament reconstruction reduces peak loads on soft-tissue graft. a biomechanical full-construct study. Arthroscopy 2022; 38 (01) 88-98
- 22 Bachmaier S, Smith PA, Bley J, Wijdicks CA. Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: a biomechanical full construct model. Arthroscopy 2018; 34 (02) 490-499
- 23 Kamiya T, Otsubo H, Suzuki T. et al. Hamstring graft prepared with suture tape is effective in anterior cruciate ligament reconstruction: a biomechanical analysis. Arthrosc Sports Med Rehabil 2021; 3 (04) e1003-e1009
- 24 Bodendorfer BM, Michaelson EM, Shu HT. et al. Suture augmented versus standard anterior cruciate ligament reconstruction: a matched comparative analysis. Arthroscopy 2019; 35 (07) 2114-2122
- 25 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10 (03) 150-154
- 26 Shelbourne KD, Barnes AF, Gray T. Correlation of a single assessment numeric evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy. Am J Sports Med 2012; 40 (11) 2487-2491
- 27 Höher J, Münster A, Klein J, Eypasch E, Tiling T. Validation and application of a subjective knee questionnaire. Knee Surg Sports Traumatol Arthrosc 1995; 3 (01) 26-33
- 28 Webster KE, Feller JA. Development and validation of a short version of the anterior cruciate ligament return to sport after injury (ACL-RSI) scale. Orthop J Sports Med 2018; 6 (04) 23 25967118763763
- 29 Delgado DA, Lambert BS, Boutris N. et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018; 2 (03) e088
- 30 Nwachukwu BU, Chang B, Voleti PB. et al. Preoperative short form health survey score is predictive of return to play and minimal clinically important difference at a minimum 2-year follow-up after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (12) 2784-2790
- 31 Weng CJ, Yeh WL, Hsu KY. et al. Clinical and functional outcomes of anterior cruciate ligament reconstruction with autologous hamstring tendon in patients aged 50 years or older. Arthroscopy 2020; 36 (02) 558-562
- 32 Lubowitz JH, Ahmad CS, Anderson K. All-inside anterior cruciate ligament graft-link technique: second-generation, no-incision anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (05) 717-727
- 33 Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med 2014; 42 (07) 1567-1573
- 34 Herzog MM, Marshall SW, Lund JL, Pate V, Spang JT. Cost of outpatient arthroscopic anterior cruciate ligament reconstruction among commercially insured patients in the United States, 2005-2013. Orthop J Sports Med 2017; 5 (01) 23 25967116684776
- 35 Kitchen BT, Mitchell BC, Cognetti DJ. et al. Outcomes after hamstring ACL reconstruction with suture tape reinforcement in adolescent athletes. Orthop J Sports Med 2022; 10 (04) 23 259671221085577
- 36 Parkes CW, Leland DP, Levy BA. et al. Hamstring autograft anterior cruciate ligament reconstruction using an all-inside technique with and without independent suture tape reinforcement. Arthroscopy 2021; 37 (02) 609-616
- 37 Nogaro MC, Abram SGF, Alvand A, Bottomley N, Jackson WFM, Price A. Paediatric and adolescent anterior cruciate ligament reconstruction surgery. Bone Joint J 2020; 102-B (02) 239-245
- 38 Paterno MV. Incidence and predictors of second anterior cruciate ligament injury after primary reconstruction and return to sport. J Athl Train 2015; 50 (10) 1097-1099
- 39 Webster KE, Feller JA, Klemm HJ. Second ACL injury rates in younger athletes who were advised to delay return to sport until 12 months after ACL reconstruction. Orthop J Sports Med 2021; 9 (02) 23 25967120985636
- 40 Kaeding CC, Aros B, Pedroza A. et al. Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 2011; 3 (01) 73-81
- 41 Ehlinger M, Panisset JC, Dejour D. et al; Francophone Arthroscopy Society (SFA). Anterior cruciate ligament reconstruction in the over-50s. A prospective comparative study between surgical and functional treatment. Orthop Traumatol Surg Res 2021; 107 (8S): 103039
- 42 Webster KE, Feller JA, Whitehead TS, Myer GD, Merory PB. Return to sport in the younger patient with anterior cruciate ligament reconstruction. Orthop J Sports Med 2017; 5 (04) 23 25967117703399
- 43 Kraeutler MJ, Kim SH, Brown CC. et al. Clinical outcomes following primary anterior cruciate ligament reconstruction with hamstring autograft versus planned hybrid graft. J Knee Surg 2018; 31 (09) 827-833
- 44 Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 (Suppl 11): S208-S228
- 45 Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone–patellar tendon–bone and hamstring-tendon autografts. Am J Sports Med 2019; 47 (14) 3531-3540
- 46 Kose O, Deniz G, Ozcan H, Guler F. A comparison of telephone interview versus on-site completion of Lysholm knee score in patients who underwent arthroscopic ACL reconstruction: are the results equivalent?. Eur J Orthop Surg Traumatol 2015; 25 (06) 1069-1072
- 47 Meta F, Lizzio VA, Jildeh TR, Makhni EC. Which patient reported outcomes to collect after anterior cruciate ligament reconstruction. Ann Joint 2017; 2 (05) 21
- 48 Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 2008; 9 (01) 9-15
- 49 Sajovic M, Stropnik D, Skaza K. Long-term comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: a 17-year follow-up of a randomized controlled trial. Am J Sports Med 2018; 46 (08) 1800-1808
- 50 Webster KE, Feller JA. Younger patients and men achieve higher outcome scores than older patients and women after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 2017; 475 (10) 2472-2480
- 51 Kelly M, Turcotte J, Thomas D. et al. Mid-term outcomes of anterior cruciate ligament reconstruction across age groups: a national database study. J Orthop 2021; 23: 150-154
- 52 van Dijck RA, Saris DB, Willems JW, Fievez AW. Additional surgery after anterior cruciate ligament reconstruction: can we improve technical aspects of the initial procedure?. Arthroscopy 2008; 24 (01) 88-95
- 53 Bodendorfer BM, Keeling LE, Michaelson EM. et al. Predictors of knee arthrofibrosis and outcomes after arthroscopic lysis of adhesions following ligamentous reconstruction: a retrospective case–control study with over two years' average follow-up. J Knee Surg 2019; 32 (06) 536-543
- 54 Cook JL, Smith P, Stannard JP. et al. A canine arthroscopic anterior cruciate ligament reconstruction model for study of synthetic augmentation of tendon allografts. J Knee Surg 2017; 30 (07) 704-711
- 55 Kessels RP. Patients' memory for medical information. J R Soc Med 2003; 96 (05) 219-222
- 56 Berlin NL, Hamill JB, Qi J, Kim HM, Pusic AL, Wilkins EG. Nonresponse bias in survey research: lessons from a prospective study of breast reconstruction. J Surg Res 2018; 224: 112-120
- 57 Greco NJ, Anderson AF, Mann BJ. et al. Responsiveness of the International Knee Documentation Committee Subjective Knee Form in comparison to the Western Ontario and McMaster Universities Osteoarthritis Index, modified Cincinnati Knee Rating System, and Short Form 36 in patients with focal articular cartilage defects. Am J Sports Med 2010; 38 (05) 891-902
- 58 Irrgang JJ, Anderson AF, Boland AL. et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2001; 29 (05) 600-613
- 59 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96