Clinical outcome 5 years after Dynamic Intraligamentary Stabilization of acute ACL ruptures

Abstract

Aims and Objectives: Dynamic Intraligamentary Stabilisation (DIS) is an anterior cruciate ligament (ACL) preserving surgical procedure for acute ACL injuries. A braided suture and a threaded sleeve containing a preloaded spring fixed into the proximal tibia provides continuous biomechanical stability. In combination with mircofracturing, self-healing of the ACL is promoted. Materials and Methods: Between January and November 2013 65 patients with an acute ACL rupture treated by Dynamic Intraligamentary Stabilisation (DIS) were included in this prospective study. Inclusion criteria were acute ACL injury, a positive Lachman test compared to the healthy contralateral side and closed growth plates. The following demographic patient data was preoperatively recorded: age, gender, weight, activity scores (Tegner, Lysholm, IKDC), type of injury, ap-translation of both knees measured by KT-1000 or Rolimeter, knee function and prior surgeries to the knees. Furthermore pivot shift test, acl rupture type, days until surgery, operating time, pre-existing pathologies and concomitant injuries were detected during surgery. The result of the reconstruction was assessed by rating it as anatomical, almost anatomical or non-anatomical. Patients were followed-up at 6 weeks, 6 months, 1 year, 2 years and 5 years after surgery. Patient satisfaction was detected recorded on a visual analog scale (VAS) scale from 0-10. Results: 34 men and 31 women were included. Mean age was 32.6 years (range 15 to 62 years). More than 70% of the injuries were soccer or handball associated. In 24 patients meniscal tears had to be repaired and in 4 patients cartilage damages had to be treated. All patients could be examinated 5 years after surgery. Within the follow up period 8 reruptures occured which were treated by one-step ACL reconstruction using an ipsilateral semitendinosus autograft. 4 patients had to be revised performing an arthrolysis due to extension deficit. At 5 years, Tegner Score averaged at 4.9 (compared to 5.5 pre-operatively). IKDC had an average of 90 (98). Lysholm score was at 95 (99). Patient satisfaction was 8.5. Conclusion: With the use of DIS, ACL preserving restoration of knee joint kinematics and mid-term survival of the repaired ACL after acute acl rupture can be achieved. Perioperative morbidity is reduced since harvesting of tendon grafts is not required. In case of recurrent instability or rerupture, conventional ACL reconstruction can still be performed. Knee function scores have shown a good rehabilitation and return to pre-trauma activity levels. However, long-term results are required to confirm safety and effectivity of the presented technique.