Abstract
PurposeAn enhanced understanding of anterior cruciate ligament (ACL) healing and advancements in arthroscopic instrumentation has resulted in a renewed interest in ACL repair. Augmentation of a ligament repair with suture tape reinforces the ligament and acts as a secondary stabilizer. This study assesses the 5-year patient-reported outcomes of primary repair with suture tape augmentation for proximal ACL tears.MethodsThirty-seven consecutive patients undergoing ACL repair with suture tape augmentation for an acute proximal rupture were prospectively followed up for a minimum of 5 years. Patients with midsubstance and distal ruptures, poor ACL tissue quality, retracted ACL remnants and multiligament injuries were excluded. Patient-reported outcome measures were collated using the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12-Item Health Survey (VR-12) and the Marx Activity Scale. Patients with a re-rupture were identified.ResultsThree patients were lost to follow-up leaving 34 patients in the final analysis (91.9%). The mean KOOS at 5 years was 88.5 (SD 13.8) which improved significantly from 48.7 (SD 18.3) preoperatively (p < 0.01). The VAS score improved from 2.3 (SD 1.7) to 1.0 (SD 1.5) and the VR-12 score improved from 35.9 (SD 10.3) to 52.4 (SD 5.9) at 5 years (p < 0.01). However, the Marx activity scale decreased from 12.4 (SD 3.4) pre-injury to 7.3 (SD 5.2) at 5 years (p = 0.02). Six patients had a re-rupture (17.6%) and have since undergone a conventional ACL reconstruction for their revision surgery with no issues since then. These patients were found to be younger and have higher initial Marx activity scores than the rest of the cohort (p < 0.05).ConclusionPrimary repair with suture tape augmentation for proximal ACL tears demonstrates satisfactory outcomes in 28 patients (82.4%) at 5-year follow-up. Six patients sustained a re-rupture and have no ongoing problems following treatment with a conventional ACL reconstruction. These patients were significantly younger and had higher initial Marx activity scores.Level of evidenceLevel IV.
Highlights
Primary repair of the anterior cruciate ligament (ACL) was often the treatment for ACL ruptures in the 1970s and 1980s [16, 42, 48]
Better outcomes have been demonstrated with primary repair of the ACL for selected patients with a proximal ACL rupture when compared to historic techniques [24, 26]
Between 2011 and 2014, 37 patients with an acute proximal ACL rupture who underwent ACL repair with suture tape augmentation within 3 months of injury were included in this study
Summary
Primary repair of the ACL was often the treatment for ACL ruptures in the 1970s and 1980s [16, 42, 48]. Failure rates of 25–53% were described at mid-term follow-up [15, 18, 33] and ACL reconstruction became the gold standard treatment in the 1990s [5, 14]. Better outcomes have been demonstrated with primary repair of the ACL for selected patients with a proximal ACL rupture when compared to historic techniques [24, 26]. This avoids donor site morbidity and in the event of revision surgery, a routine ACL reconstruction can be performed. It is thought that the loss of these fibres can lead to a lack of confidence in the knee, which is a common complaint of patients following ACL reconstruction, despite restoration of joint laxity [6, 8, 20]
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