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Promising functional outcomes following anterior cruciate ligament repair with suture augmentation

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There has been a renewed interest in the repair of the torn anterior cruciate ligament (ACL). Purpose of this study was to evaluate the functional outcome of arthroscopic ACL repair with additional suture augmentation (SA), hypothesizing that isolated ACL ruptures would yield superior patient-reported outcome measures (PROMs) compared to those with concomitant meniscal and/or ligamentous injuries.

Methods

This is a retrospective analysis of 93 consecutive patients (67 female, median age 42 years) who underwent arthroscopic ACL repair with SA between January 2017 and March 2019 for an acute traumatic ACL tear confirmed by magnetic resonance imaging (MRI). Patients with pre- or intraoperative mid-substance or distal ACL tears and/or poor tissue quality of the ACL remnant were not considered for ACL repair but were scheduled for an ACL reconstruction with a tendon autograft. In patients who underwent ACL repair with SA, the SA construct was proximally stabilized with a flip-button and distally with a suture anchor. Surgery was preferably performed on the day of injury and all surgeries were performed by the same surgeon. Postoperative rehabilitation included partial weight-bearing (20 kg) for 6 weeks and immobilization in a brace limited at 90-degrees of knee flexion for 4 weeks. Patient-reported outcome measures (PROMs) were determined using International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm Score (LS), Tegner Activity Score (TS) and Forgotten Joint Score (FJS). Knee-laxity was assessed using the KT-1000 arthrometer (Med Metrics Corp. Inc., San Diego, USA).

Results

Nine patients underwent revision surgery for a traumatic re-tear (four patients) and chronic instability (five patients) and were excluded from further functional analysis. Functional results of 77 patients (54 female) with a median age of 44 years (IQR 33–51) on the day of surgery were available for follow-up after a median time of 35 months (IQR 33–44). Concomitant injuries were observed in 66 Patients (86%), meniscal injuries in 43 patients (55%) and ligamentous injuries in 50 patients (65%). Median interval from injury to surgery was 1 day (IQR 0–1) with 81% (62/77) of patients being treated within 24 h of injury. The median IKDC was 92 (IQR 86–99), the median LS was 95 (IQR 86–100), the median pre-traumatic TS was 7 (IQR 6–7), the median post-traumatic TS was 6 (IQR 5–7) with a non-significant median difference (TSDiff) of 0 (IQR 0–1). The median FJS was 95 (IQR 78–98). KT-1000 measurements were available in 34 of 77 patients with a median postoperative laxity compared to the uninjured side of 1 mm (IQR 0–2). Interval from injury to surgery, patients’ age, body mass index (BMI), knee laxity and concomitant ligamentous or meniscal injuries had no statistically significant impact on postoperative PROMs (n.s.).

Conclusion

Following arthroscopic ACL repair with SA good-to-excellent functional results were observed. However, a failure rate of 10% cannot be neglected and warrants further attention. Concomitant injuries to the meniscus and/or collateral ligaments do not seem to be associated with inferior PROMs.

Level of evidence

Level IV.

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Data availability

All data generated or analyzed during this study are included in this manuscript.

Abbreviations

ACL:

Anterior cruciate ligament

BMI:

Body mass index

DIS:

Dynamic intraligamentary stabilization

FJS:

Forgotten Joint Score

IKDC:

International Knee Documentation Committee

IQR:

Interquartile range

LS:

Lysholm Score

MRI:

Magnetic resonance imaging

PROM:

Patient-reported outcome measures

SA:

Suture augmentation

TS:

Tegner Activity Score

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Acknowledgements

The authors thank Anita Baschung, Tina Bricalli, Julia Erschbamer, Iris Pellegrinelli, Katrin Spieske and Michael Bauer for their help with data collection and data management. We acknowledge support from the Open Access Fund of the University of Münster.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, Klinik Gut, Via Arona 34, 7500, St. Moritz, Switzerland

    K. N. Schneider, Georg Ahlbäumer, J. Weller & A. Goth

  2. Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany

    K. N. Schneider, G. Gosheger & C. Theil

  3. Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany

    A. Goth

Authors
  1. K. N. Schneider
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  2. Georg Ahlbäumer
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  5. J. Weller
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Contributions

KNS, GA and AG designed the study and collected the data. KNS, GA, CT and AG were responsible for data management, data analysis and preparation of figures. KNS, GA and AG wrote the manuscript. CT and GG helped with data analysis and with editing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Georg Ahlbäumer.

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Conflict of interest

All authors declare that they have no competing interests.

Ethical approval

The study was approved by the Kantonale Ethikkommission Zürich/Switzerland (reference number 2019–00758) and performed in accordance to the Declaration of Helsinki.

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Informed consent was obtained from all patients.

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Schneider, K.N., Ahlbäumer, G., Gosheger, G. et al. Promising functional outcomes following anterior cruciate ligament repair with suture augmentation. Knee Surg Sports Traumatol Arthrosc 31, 2836–2843 (2023). https://doi.org/10.1007/s00167-022-07236-4

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  • DOI: https://doi.org/10.1007/s00167-022-07236-4

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