Abstract
PurposeTo evaluate and compare subjective and objective knee outcomes following hamstring tendon (HT) and quadriceps tendon (QT) anterior cruciate ligament reconstruction (ACLR) with or without suture tape (ST) reinforcement. It was hypothesized that the addition of an intra-articular synthetic augmentation with a ST would reduce postoperative knee laxity and graft ruptures after ACLR.MethodsA 1:1 matched-cohort comparison of patients who underwent HT and QT autograft ACLR with or without ST reinforcement was performed. Patients with ST reinforcement were consecutively assigned to the study groups until a number of 20 in each group was achieved. Medical records were reviewed for demographic characteristics and additional injuries. Laxity measurements with KT-1000, strength measurements and physical examination findings were collected both preoperatively and at 6 months and patient reported outcome (PRO) scores were collected both preoperatively and at 12 months, and comparison was made HT vs HT + ST and QT vs QT + ST. Reoperations and re-ruptures were recorded during the 24-month follow-up period.ResultsOverall, 80 patients who underwent ACLR were included. Patients with HT + ST had significant less laxity postoperatively compared to HT at 6 months, 1.9 vs 0.8 mm, p < 0.05. No differences were found between the QT and QT + ST group. At 6 weeks patients treated with ST, both QT and HT, had a significant deficit in flexion compared to those without ST. However, this resolved at 6 months. There were no significant differences between HT + ST vs HT, or QT + ST vs QT, regarding postoperative PROs or strength measurements. Furthermore, the incidence of subsequent surgery and graft rupture was not significantly different between the groups.ConclusionACLR with HT + ST reduces laxity at 6 months compared to ACLR without ST, a difference not seen when ACLR was performed using QT with or without ST. No other differences were seen between the two techniques comparing subjective and objective findings.Level of evidenceLevel III.
Highlights
Anterior cruciate ligament (ACL) reconstruction (ACLR) is a common orthopedic procedure, aiming at reducing knee instability
anterior cruciate ligament reconstruction (ACLR) techniques have developed over the years and are today performed with an anteromedial femoral drilling technique, allowing a more anatomical positioning of the graft, the risk for subsequent surgery is still high [1, 2]
The rates of ACL revision surgery have been reported at 2–3% within the first two to three years and an overall revision rate of approximately 4% is reported in the Swedish Knee Ligament Registry (SKLR)
Summary
Anterior cruciate ligament (ACL) reconstruction (ACLR) is a common orthopedic procedure, aiming at reducing knee instability. ACLR techniques have developed over the years and are today performed with an anteromedial femoral drilling technique, allowing a more anatomical positioning of the graft, the risk for subsequent surgery is still high [1, 2]. An ACL graft von Essen et al Journal of Experimental Orthopaedics (2022) 9:20 tear is detrimental to patient outcomes following ACLR. Systematic reviews indicate that one can expect a failure rate between 3.5 and 7% of autografts, increasing up to 10–28% in a high-risk population [3,4,5,6]. The rates of ACL revision surgery have been reported at 2–3% within the first two to three years and an overall revision rate of approximately 4% is reported in the Swedish Knee Ligament Registry (SKLR). It is evident that the outcome after revision ACLR is inferior to that of a primary ACLR [7,8,9,10,11]
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