Tape Augmentation Research Articles

Comparison of Suture Anchor Repair and Suture Tape Augmentation for Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Study

ABSTRACTObjectivesCurrently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all‐inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing.MethodsEighteen fresh‐frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness.ResultsThe mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL.ConclusionsIn terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL.

Modified Broström vs Suture Tape Augmentation: A Systematic Review

Ankle sprains are common musculoskeletal injuries which can develop into residual chronic lateral ankle instability. When non-surgical treatments fail, surgical intervention is often indicated. We performed a systematic review of the literature comparing outcome measures of modified Broström repair to suture tape augmentation for lateral ankle stabilization. All studies available in PubMed up to July 2023 were screened. Three randomized controlled trials involving 235 patients met inclusion criteria. All the studies reported on Foot and Ankle Ability Measure, two of the three studies found higher postoperative Sports Activity scores in the suture tape group. Two of the studies reported Foot and Ankle Outcome Score, neither were found to be significantly different. The third study analyzed return to pre-injury level of activity between the two surgical techniques and found a faster return to activity for suture tape compared to modified Broström procedure. Overall, outcome measures show no significant difference between modified Broström and suture tape augmentation.

Trends in Anterior Cruciate Ligament Reconstruction Techniques and Postoperative Care Among Leaders in the Field: A Survey of the Herodicus Society.

Despite a growing body of literature regarding anterior cruciate ligament reconstruction (ACLR), there remains a wide diversity in surgical technique and clinical practice across providers. To (1) describe current ACLR practice preferences among members of the Herodicus society and (2) determine whether these preferences are influenced by years in practice and overall surgical volume. Cross-sectional study. A 24-question survey investigating surgeons' practices and preferred ACLR surgical techniques was sent via email to all active Herodicus Society members. Survey responses were subdivided by years of experience and overall ACLR annual case volume. Descriptive statistics were compiled and chi-square testing was utilized to determine the significance of experience and case volume on survey responses. Of the 113 invited Herodicus Society members who perform ACLR, 69 (61%) completed the survey. Respondents had a mean ± SD of 30.9 ± 9.8 years of experience in clinical practice and performed a mean of 96.0 ± 50.7 primary and 21.6 ± 16.9 revision ACLR annually. Of revision cases, 72.1% were performed using a single-stage technique. Mean frequency of graft usage by surgeon was bone-patellar tendon-bone autograft (58.6%), quadriceps autograft (14.6%), hamstring tendon autograft (14.0%), and allograft (11.8%). The plurality of surgeons responded that they used anterolateral augmentation "rarely" in primary ACLR (39.1%) and "sometimes" in revision ACLR (31.9%), with the majority performing lateral extra-articular tenodesis (66.7%) rather than anterolateral ligament reconstruction (14.5%). Most surgeons would not allow a 20-year-old football player to return before 7 months after ACLR (71.0%) but highly valued return-to-sports testing to determine readiness (94.2%). Higher volume surgeons performed single-stage revision ACLR at a significantly higher rate (79.8% vs 62.9%, P = .02) and significantly differed in return-to-sports criteria, with a greater proportion relying primarily on biometric testing (P = .01). The survey demonstrated that, in the Herodicus Society, a wide range of preferences exist regarding ACLR surgical technique. Bone-patellar tendon-bone autograft is the most frequent primary ACLR graft choice. Most participants have not embraced newer techniques such as anterolateral or suture tape augmentation. Return to sports is generally not allowed before 7 months and heavily factors-in return-to-sports testing metrics, suggesting that purely time-based criteria for return to sports is not modern practice among elite sports medicine surgeons.

Risk for Revision ACLR After Primary All-Inside Quadrupled Semitendinosus Hamstring Tendon Autograft ACLR With Independent Suture Tape Augmentation: A Retrospective Cohort Study.

The rate of failed anterior cruciate ligament reconstruction (ACLR) remains high in the younger and more active patient populations. Suture tape augmentation (STA) in addition to ACLR may reduce the risk for revision surgery. The purpose of this study was to compare patient outcomes between patients who underwent primary all-inside quadrupled semitendinosus hamstring tendon autograft (QST-HTA) ACLR with and without STA. It was hypothesized that the STA cohort would demonstrate a lower incidence of subsequent revision ACLR while maintaining comparable patient-reported outcomes. Cohort study; Level of evidence, 3. All patients ≤40 years of age who received primary all-inside QST-HTA ACLR with and without independent STA augmentation were identified. The following validated patient-reported outcome measures (PROMs) were collected: visual analog scale for pain, Single Assessment Numeric Evaluation, Knee injury and Osteoarthritis Outcome Score subscales, and Tegner activity scale. KT-1000 arthrometer measurements were collected pre- and postoperatively. Cox proportional hazards model and nominal logistic regression analysis were used to assess additional variables associated with revision ACLR. A total of 104 patients with a mean age of <22 years were included in the final data analysis (STA: 36 patients; control: 68 patients). Significantly fewer patients in the STA group sustained a graft failure necessitating revision surgery at the final follow-up (5.6% vs 24%; relative risk, 0.24 [95% CI, 0.06-0.97]; P = .017). Four-year graft survival was significantly higher in the STA group (97.2% vs 82.4%; P = .031). All PROMs significantly improved postoperatively except for Tegner levels, which decreased in both groups compared with their preinjury levels (P < .001). Return to sports was similar in both groups with >70% of patients returning to their previous level of competition. Regression analysis demonstrated increased risk for revision ACLR in younger patients, high school athletes, and those with higher postoperative activity levels. QST-HTA ACLR with STA was associated with reduced risk for revision ACLR compared with nonaugmented QST-HTA ACLR in this young patient population. Furthermore, the addition of suture tape did not appear to affect postoperative patient-reported and return-to-sports outcomes.

Countermovement jump and vertical hop demonstrate braking/deceleration and performance alterations after ACL reconstruction with BMA, DBM, and suture tape augmentation

ObjectivesThis study evaluated countermovement jump and Single Leg Jump measures to identify landing measures that best distinguish a novel Anterior Cruciate Ligament reconstruction technique using bone marrow aspirate, demineralized bone matrix, and suture tape augmentation patients from controls. The secondary objective assessed performance differences between operated and non-operated limbs post-reconstruction. The hypothesis was that novel Anterior Cruciate Ligament reconstruction patients at return to sport would not differ from controls during landing and that the operated limb's performance would not differ from the unoperated limb. MethodsThe study included 31 patients with the novel reconstruction technique matched with controls in a 1:10 ratio based on age, sex, weight, and height. Both groups underwent screening and were compared during a Countermovement Jump. Using a Sparta Science Force Platform, each patient's unoperated and operated limbs were also compared for Single Leg Jump post-op (6.5 months). ResultsTest patients showed no difference in center of pressure during landing of both jumps compared to controls (P=0.27) and the uninvolved limb (P=0.26). Test patients exhibited increased braking impulse relative to the uninvolved limb during Single Leg Jump (P<0.001). Deceleration upon landing of Countermovement Jump was also increased compared to controls (P<0.001). Test patients demonstrated slower concentric time during a Countermovement Jump compared to controls (P=0.03) and significantly slower compared to the uninjured leg (P<0.001). Countermovement Jump height was decreased compared to controls (P<0.001). Single-leg jump height was decreased in the injured limb compared to the uninjured limb (P<0.001). ConclusionsTest patients did not show significant differences in landing motion compared to controls or the uninvolved leg. However, power and performance alterations were evident at Return to Sport after reconstruction. Although these results are quite promising, they may be too preliminary to draw definitive conclusions. Double and single-legged assessments should be considered in return-to-sport decision-making.

Arthroscopic Anterior Talofibular Ligament Repair Combined With All-Inside Suture Tape Augmentation for Treatment of Chronic Lateral Ankle Instability With Generalized Joint Laxity.

To analyze the feasibility and clinical results of the modified Broström operation (MBO) combined with suture tape augmentation under arthroscopy for chronic lateral ankle instability (CLAI) in patients with generalized joint laxity (GJL). From October 2019 to October 2021, a total of 111 patients (111 ankles) treated with MBO combined with suture tape augmentation under arthroscope were retrospectively divided into a GJL group (29 patients) and a control group (82 patients). Mechanical stability of the affected ankle joint was evaluated radiographically preoperatively, at 6 months postoperatively, and the last follow-up. Complications and surgical failures, as well as visual analog scale (VAS) score, the Foot and Ankle Ability Measure (FAAM), and the Karlsson score were also recorded. All statistical analyses were completed using SPSS 20.0. The average follow-up time was 21.7 ± 5.2 months for the GJL group, and 20.9 ± 5.3 months for the control group. Pain and symptoms in both groups were effectively relieved by the procedure reflected by decreased VAS scores, improved FAAM and Karlsson scores at 6 months postoperatively, and the final follow-up (P < .05). Preoperative talar tilt angle and anterior talar translation were significantly greater in the GJL group than those in the control group (P < .05). Postoperatively, both talar tilt angle and anterior talar translation were reduced in both groups at 6 months postoperatively and the last follow-up (P < .05), and we found no significant difference between the two groups (P > .05). Furthermore, we found no significant difference in VAS, FAAM, and Karlsson scores between the 2 groups 6 months postoperatively and at the last follow-up. Arthroscopic MBO combined with suture tape augmentation is a reliable procedure for treating CLAI with GJL. At short-term follow-up, we found that the GJL group achieved an equivalent level of stability compared with the control group.

All-Inside Anterior Cruciate Ligament Reconstruction Using Full-Thickness All-Soft-Tissue Quadriceps Tendon Autograft With Independent Suture Tape Augmentation

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament that requires surgical intervention. Surgical options to address ACL ruptures include reconstruction using autograft or allograft or performing primary repair. Subsequent ACL graft failure is a significant postoperative concern in the younger patient population. The addition of suture tape to the final construct is thought to protect the graft during moments of high stress by increasing graft stiffness under high load and preventing substantial graft elongation. Given the normal anatomic lengthening of the ACL from knee flexion to full extension, final fixation of both the suture tape and the graft is done with the knee hyperextended to avoid overconstraint. The use of adjustable loop fixation for both femoral and tibial fixation with the all-inside technique allows the graft to be retensioned after final suture tape fixation and subsequent knee cycling. This ensures that the suture tape is slightly laxer than the graft so that the graft experiences loads that are essential for its healing, with the suture tape sharing the load only during times of high stress.

Medial Ligament Complex Reconstruction With Allograft Using Less Invasive Onlay Fixation and Suture Tape Augmentation

Injury to the medial complex of the knee may result in persisting valgus and rotatory instability. In combination with concomitant meniscotibial ligament disruption, maldistributed contact forces are placed on the medial compartment, which may result in the progression of osteoarthritis. When facing chronic valgus and/or posteromedial instability, definitive treatment with medial ligament complex reconstruction in combination with additional repair of the meniscotibial ligament when necessary should be done to anatomically restore proper knee biomechanics and kinematics. This technique describes reconstruction of both the superficial medial collateral ligament (sMCL) and posterior oblique ligament with a single allograft, with additional suture tape augmentation used to reinforce the sMCL. Additionally, less invasive onlay fixation is used via a knotless loop mechanism to secure the posterior oblique ligament to its tibial insertion and the sMCL at 2 points along its distal tibial insertion.

Poster 169: Preliminary Outcomes of Revision UCL Repair With Suture Tape Augmentation for Failure of Primary UCL Reconstruction in Professional and Collegiate Pitchers

Objectives: Injury of the ulnar collateral ligament (UCL) is common in baseball players and pitchers, in particular. The gold standard surgical treatment has been UCL reconstruction with autograft, although, UCL repair with collagen-coated suture tape has shown promise as an alternative recently. The outcomes of UCL reconstruction and UCL repair are well-studied, demonstrating high rates of return to sport and a predictable postoperative course of recovery. However, revision UCL reconstructions with allografts do not demonstrate comparable outcomes when compared with primary procedures. This pilot case series reports on the preliminary outcomes of collegiate and professional pitchers who underwent revision UCL repair with collagen-coated suture tape following failure of primary UCL reconstruction. Methods: We performed a retrospective query of a prospectively collected data repository to identify patients at our institution who had undergone UCL repair with internal brace. Additional inclusion criteria included: 1) prior failed UCL reconstruction with autograft; 2) aged between 15 and 45 years; 3) at least 1-year post-operative. From the included cohort, we collected demographic, clinical, and surgical data from the electronic health record. We further collected patient-reported outcomes data using either a web-based database platform or via telephone, including the American Shoulder and Elbow Surgeons Elbow assessment form (ASES-E; satisfaction, pain, and function subscales), the Kerlan Jobe Orthopaedic Clinic Shoulder and Elbow score (KJOC), Andrews Carson score, and information on return-to-sport timing and success. To evaluate outcomes, we reported the proportions of athletes that were able to successfully return-to-sport at the preinjury level or higher as well as return-to-sport timing and level of competition. Additionally, we reported summary statistics for patient-reported questionnaires evaluated at follow-up (ASES-E, KJOC, and Andrews Carson). Results: A total of 10 patients met inclusion criteria, and all were professional or collegiate pitchers at the time of their revision UCL repair surgery (40% professional and 60% collegiate). The mean follow-up time was 3.0 years (Table 1; range: 1-5 years). Table 1 shows complete return-to-sport data. All patients were able to return-to-sport at the same or higher level, and the mean time from surgery to return-to-sport was 9.3 months. Table 2 shows complete patient-reported outcomes data. Mean scores on elbow-related function questionnaires were high (ASES-E Function = 35.8 out of a maximum best of 36; KJOC = 88.3 out of a maximum best of 100; Andrews Carson = 94.5 out of a maximum best of 100) and mean pain scores were low (ASES-E Pain = 1 out of a maximum worst score of 50). Conclusions: This pilot case series demonstrated promising results of a novel UCL repair approach utilizing collagen-coated suture tape for high-level pitchers with recurrent medial elbow instability following initial UCL reconstruction with autograft. Specifically, we found excellent return-to-sport success and patient-reported outcomes in this preliminary cohort. Further study is warranted with larger sample sizes to further evaluate outcomes following revision of UCL reconstruction with UCL repair utilizing internal bracing.

Anterior Cruciate Ligament Reconstruction Augmentation With Bone Marrow Aspirate Concentrate, Demineralized Bone Matrix, and Suture Tape Shows No Difference in Outcomes—But Faster Functional Recovery—Versus Non-augmented Anterior Cruciate Ligament Reconstruction

PurposeTo compare outcomes after anterior cruciate ligament reconstruction (ACLR) with bone marrow aspirate concentrate (BMAC), demineralized bone matrix (DBM), and suture tape augmentation (STA) vs. ACLR without biologic augmentation or STA. MethodsA prospective randomized controlled trial at a single institution was performed to compare ACLR with BMAC, DBM, and STA (Group A) vs. ACLR without biologic or STA (Group NA). One hundred patients were required. Skeletally mature patients <25 years old received quadriceps tendon autografts, while patients ≥25 years old received allograft ACLR with an all-inside technique. Concomitant meniscal pathologies were included. Primary outcomes compared were range-of-motion (ROM), limb symmetry, and patient-reported outcomes (PROs). Secondary outcomes included radiographic outcomes and surgical complications. Univariate and mixed-model regression analysis were used to compare outcomes. ResultsFifty-nine patients were included (Group A: 29 patients, 11 females, 38%; Group NA: 30 patients, 15 females, 50%). Early range-of-motion at 6 weeks (125° vs 109° flexion, p<0.0001) and limb symmetry testing at 12 weeks (80.6 % vs. 36.7% [Delta 43.9%], p<0.001) were significantly improved in Group A. At two years, International Knee Documentation (IKDC) scores were similar (91.1 ± 12.7 vs. 85.3 ± 10.8, p=0.109). Knee Injury and Osteoarthritis and Outcome Score (KOOS) Quality of Life (QOL) scores were significantly enhanced in Group A (85.2 ± 20.9 vs. 72.1 ± 20.4, p=0.042). Twenty-two patients (12 Group A, 10 Group NA) underwent CT scans at 6-months to compare bone tunnel healing. Overall, the mean increase in bone tunnel diameter was significantly smaller in Group A vs. NA. No difference in graft re-ruptures or re-operations was observed. Seven of 59 patients (11.9%) underwent re-operation for stiffness (A: 3 (10%) vs. NA: 4 (13%), p=1.0). ConclusionThere were no differences in IKDC scores between groups at 2-year follow-up. Functional outcomes including early range-of-motion and limb symmetry were significantly improved in patients who received ACLR with BMAC, DBM, and STA. ACLRACLR.ACLR

Multiligament Knee Reconstruction With Suture Tape Augmentation: Patient-Reported Outcomes at Minimum 2-Year Follow-up.

Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation. A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores. Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36. Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [Orthopedics. 2024;47(4):238-243.].

Anterior Cruciate Ligament Repair With Suture Tape Augmentation of Proximal Tears and Early Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation Result in Comparable Clinical Outcomes With Anterior Cruciate Ligament Reconstruction at 2-Year Follow-Up

To compare the postoperative side-to-side laxity and short-term clinical outcomes of patients who received primary anterior cruciate ligament (ACL) repair with suture tape augmentation, acute anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation performed within 8 weeks of injury (ACLRacute), or ACLR beyond 8 weeks of injury. After institutional review board approval was obtained, 100 patients were enrolled in this prospective trial: 34 primary ACL repair with suture tape augmentation, 33 ACLRs performed within 8 weeks of injury (ACLRacute), and 33 ACLRs. Patients were allocated to ACL repair if a proximal avulsion was present with good tissue quality (Sherman type 1), confirmed by intraoperative diagnostic arthroscopy. Preoperative side-to-side anteroposterior knee laxity was assessed with KT-1000 arthrometer, and patient-reported outcomes (PROs) including the visual analog scale, Marx activity scale, Veterans RAND 12-item health survey (VR-12 physical & mental), Single Assessment Numeric Evaluation, Knee Injury and Osteoarthritis Outcome Score survey subscales, and range of motion were collected. These objective and subjective measures were repeated at regular intervals postoperatively through 2 years. Minimal clinically important difference calculations were performed assessing postoperative PRO changes at 2 years compared with preoperative. The average time from injury to surgery was 5.03 ± 1.2 weeks for the ACL repair group, 5.09 ± 0.74 weeks for the ACLRacute, and 43.22 ± 33.5 weeks for the ACLR group. Postoperatively, the KT-1000 side-to-side laxity difference for 30 lbs was determined to be 0.1 ± 0.37 (95% confidence interval [CI] -0.7 to 0.8) for ACL repair versus ACLR (P < .0001), -0.8 ± 0.35 (95% CI -1.5 to -0.1) for ACLRacute versus ACLR (P < .0001), and 0.8 ± 0.40 (95% CI 0.0-1.6) for ACL repair versus ACLRacute (P < .0001). The data reveal ACL repair and ACLRacute are noninferior to ACLR at 2-year follow-up. The postoperative difference from baseline for all PROs demonstrated improvement for all PROs. Magnetic resonance imaging at 1 year revealed tissue healing for the 3 ACL injury treatment groups. Patients who underwent ACL repair of proximal tears with suture tape augmentation or ACL reconstruction within 8 weeks from injury resulted in noninferior side-to-side knee laxity, comparable PROs, and similar range of motion at 2-year follow-up compared with ACLR. Level II, prospective comparative study.

Ligament Suspensionplasty With Suture Tape Augmentation​ for Basal Thumb Arthritis.

Thumb carpometacarpal arthritis is common with aging, more common in women than men, and usually occurs after age 40. If a patient fails conservative treatments such as splinting, medications, and corticosteroid injections, then surgical intervention may be appropriate. Currently, there is no consensus on the best surgical treatment. By limiting metacarpal subsidence, ligament suspensionplasty with suture tape augmentation offers great pain relief, excellent functional outcomes, and limited postoperative immobilization. With this technique, trapeziectomy is first performed. A portion of the abductor pollicis longus tendon is resected and loaded onto the SwiveLock anchor using 4-0 FiberLoop, in addition to suture tape. The prepared graft and tape construct is anchored into the lateral first metacarpal (MC) base and index metacarpal base. After surgery, patients are put in a short arm thumb spica splint, interphalangeal (IP) joints free. Active motion is initiated at the first postoperative visit, usually within 1 week. All patients who had thumb arthritis treated with carpometacarpal suspensionplasty and suture tape augmentation between 2015 and 2022 by a single hand surgeon at our institution were queried. A total of 110 patients were invited to take part in this study, and 61 patients consented and were included in this study. Mean last in-office follow up was at 7.5±4.0 months, which showed significant improvements in pinch strength (P=0.011). A survey taken at a mean 2.8±1.3 years (range: 0.5 to 5.2y) after surgery reports a postoperative DASH score of 7.3±7.7 (range: 0 to 23.3), and VAS pain score of 0.7±1.1 (range: 0 to 5).

A ‘STRONG REGIME’ FOR SAFE ANKLES: A PROSPECTIVE STUDY TO VALIDATE AN EARLY MOBILIZATION PROGRAMME AFTER A LATERAL ANKLE LIGAMENT REPAIR WITH SUTURE TAPE AUGMENTATION

ObjectiveTo evaluate early mobilization with the ‘STRONG regime’ is safe after lateral ankle ligament repair with suture tape augmentation.BackgroundThe ESSKA-AFAS ankle instability group presented in 2016 evidence-based guidelines for rehabilitation and return to activity after lateral ankle ligament repair. Early mobilization is considered an important element of postoperative rehabilitation. Patients have to be immobilized for approximately six weeks to protect the delicate repair. Lateral ankle ligament repair with suture tape augmentation results in greater strength compared with standard repairs and early mobilization proved to be successful in small sample size studies. Augmented surgery technique is getting increasingly popular. However, it is unknown which rehabilitation regimes are used. It is essential to establish a clear evidence-based guideline for rehabilitation after surgery.MethodsA systematic literature search was performed to obtain the best evidence research regarding this surgery. In cooperation between the orthopaedic- and physical therapy department a post-operative rehabilitation protocol with early mobilization was established. This STRONG protocol (figure 1) is based on milestones and three stages.ResultsIn February 2016 the first patients were selected for the early mobilization regime. In total 102 patients with a lateral ankle ligament repair were treated with the STRONG protocol. No re-ruptures were observed with a follow up of a year. In a subgroup of athletes hop tests showed a symmetry index of 100,5% for triple hop, 98,6 for side hop and 103,6 for figure of 8 hop. First return to sport was achieved between 9–12 weeks, with full return to competition after a mean of 4 months.ConclusionsAn early postoperative mobilization regime based on supervised exercises seems to be a safe intervention after a lateral ankle ligament reconstruction.Clinical implicationsAugmented ankle ligament surgery with early mobilization could be an important advancement in treating patients with chronic ankle injuries.For any figures or tables, please contact authors directly.

Medial Patellofemoral Ligament Augmentation Repair for Primary Patellar Dislocation With Concomitant Chondral or Osteochondral Injury in Children and Adolescents: Outcomes at Minimum 2-Year Follow-up.

Treatment of primary patellar dislocation (PPD) with chondral or osteochondral injury without patellar stabilization in the adolescent population may lead to unsatisfactory outcomes. Surgical treatment, with or without traditional medial patellofemoral ligament (MPFL) reconstruction, is a topic of interest. To compare postoperative outcomes and rates of patellar redislocation and return to the operating room (OR) in patients who sustained a PPD with chondral or osteochondral injury and were surgically treated with versus without suture tape augmentation repair of the MPFL. Cohort study; Level of evidence, 3. Adolescents who sustained a PPD with chondral or osteochondral injury confirmed via magnetic resonance imaging (MRI) and who were treated by a single surgeon between January 2009 and November 2020 were retrospectively reviewed. Patients were grouped into those who underwent chondral or osteochondral treatment with suture tape augmentation repair of the MPFL (ST group; n = 20) and those who did not have suture tape augmentation or repair (no-ST group; n = 20; 11 patients within the no-ST group did undergo medial imbrication). Demographic characteristics, postoperative knee range of motion, pre- and postoperative radiographic measurements, and preoperative MRI parameters were recorded, and minimum 2-year patient-reported outcomes were collected. Data were compared between the ST and no-ST groups. The mean patient age was 15.02 years (range, 12.64-17.61 years) in the ST group and 14.18 years (range, 10.56-16.38 years) in the no-ST group, with a mean follow-up of 3.63 years (range, 2.01-6.11 years) in the ST group and 4.98 years (range, 2.23-9.03 years) in the no-ST group. Significantly more patients returned to the OR in the no-ST group compared with the ST group (7 [35%] vs 0 [0%]; P = .008). Further patellar stabilization with an MPFL allograft (n = 5) and manipulation under anesthesia (n = 2) were reasons for returning to the OR. There were no redislocation events in the ST group. Treating PPDs with chondral or osteochondral injury using suture tape to augment and repair the MPFL has promising advantages over not repairing it-including lower rates of postoperative patellar instability and return to the OR.

Quadriceps Tendon Autograft ACL Reconstruction With Suture Tape Augmentation: Safe Results Based on Minimum 2-Year Follow-up MRI.

The potential intra-articular effects of ≥1 year after anterior cruciate ligament reconstruction (ACLR) with independent suture tape augmentation (STA) are not fully understood. To investigate whether incorporating suture tape in an all-soft tissue quadriceps tendon autograft (QTA) ACLR leads to satisfactory patient outcomes while having no intra-articular side effects as determined by magnetic resonance imaging (MRI). Case series; Level of evidence, 4. Included were 25 patients with a mean age of 19.9 years (95% CI, 17.3-22.5 years) who underwent QTA ACLR with STA between 2016 and 2019. All patients underwent MRI at ≥1 year postoperatively and had at least a 2-year follow-up (mean, 28 months [95% CI, 26.5-29.5 months]) that included physical examination with anterior laxity testing with KT-1000 arthrometer, radiographs, and patient-reported outcome measures (PROMs). At the final follow-up, the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for applicable PROMs were applied to each patient. Postoperative graft and joint integrity were assessed using the Howell classification and the MRI Osteoarthritis Knee Score (MOAKS) joint effusion/synovitis grade. The Mann-Whitney U test for continuous variables and the chi-square or the Fisher exact test for categorical variables were used for statistical analyses. The MRI assessment of the grafts demonstrated intact grafts in all patients. Overall, 96% of patients demonstrated grades 0 or 1 MOAKS for joint effusion/synovitis. All patient outcomes significantly improved from preoperatively to the final follow-up (P < .001), except for the Marx score, which decreased significantly (14.2 [95% CI, 12.7-15.8] vs 9.72 [95% CI, 7.3-12.2]; P = .0014). At least 68% of the patients achieved the MCID threshold, and 92% achieved the PASS threshold for all applicable PROMs. QTA ACLR with STA did not demonstrate adverse intra-articular changes on MRI at ≥1 year postoperatively. In addition, STA did not appear to negatively affect PROMs.

Primary All-Soft Tissue Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation Resulted in Satisfactory Patient Outcomes and a Low Graft Failure Rate in High School and Collegiate Athletes

To evaluate ≥2-year patient outcomes after primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes. All high school and collegiate athletes who underwent primary ASTQ ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated patient-reported outcome measures (PROMs) pre- and postoperatively. The minimal clinically important difference was calculated for each PROM based on this study population and applied to the individual patient. Return to sport, subsequent surgical intervention including contralateral ACLR, and KT-1000 arthrometer measurements for knee laxity were collected. Complications were assessed by physical examination, radiologic studies, or obtained via telephone. In total, 60 patients were included in the final data analysis, with a mean age of 16.8 years (95% confidence interval 13-23) and mean final follow-up of 37.1 months (95% confidence interval 33.1-41.1). Twelve patients (20%) required subsequent surgery on the ipsilateral knee, which included 7 patients having a subsequent meniscal procedure and 3 patients who underwent arthrolysis. None sustained a graft failure, and 6 patients sustained a contralateral ACL injury necessitating surgery. All PROMs improved at the final follow-up (P < .001). In addition, KT-1000 arthrometer measurements significantly improved postoperatively at 1-year clinical follow-up (P < .001). Most patients obtained the minimal clinically important difference thresholds for each PROM at the final follow-up. There were 48 patients (80%) who participated in pivoting sports. The return-to-sport rate at same level was 54 patients (90%), with 6 patients (10%) not returning to the same level because of graduation. ASTQ ACLR with STA in a young athletic patient population may result in a low graft failure rate while maintaining satisfactory patient outcomes at short-term follow-up, including a return to sport at the same level of 90%. Level IV, retrospective case series.

Less Subsequent Revision Anterior Cruciate Ligament Reconstruction Following Primary Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation—A Retrospective Comparative Therapeutic Trial With 5-Year Follow-Up

To investigate patient outcomes, including revision rate, following primary bone patellar-tendon bone autograft (BPTB) anterior cruciate ligament reconstruction (ACLR) with and without suture tape augmentation (STA) in a young and active cohort. All eligible patients who received primary BPTB ACLR with a minimum of 2-year follow-up were included in this retrospective cohort study. All patients receiving STA were augmented with the same device. Patients completed the following patient-reported outcome measures (PROMs): the visual analog scale, the Single Assessment Numeric Evaluation, the Knee Injury and Osteoarthritis Outcome Score subscales, and the Tegner activity scale. Anteroposterior knee laxity was assessed using a KT-1000 arthrometer preoperatively and 1-year postoperatively. Posterior tibial slope, femoral tunnel angle, and tibial tunnel placement were calculated for all patients. Subsequent surgical interventions and return to sport (RTS) were obtained from each patient. One hundred fourteen patients (52 BPTB ACLR with STA, 62 traditional BPTB ACLR) with a mean patient age <19 years and a mean final follow-up of ≥5 years were included. Compared with the control group, the STA group demonstrated significantly less subsequent revision ACLR (0 vs. 5, P= .036). All PROMs and KT-1000 measurements improved at final follow-up (P<.001) and were comparable between groups. There were no differences seen in either posterior tibial slope or graft tunnel placement between groups. More than 85% of the patients were able to return to the sport that led to their injury at full capacity with no differences seen in RTS rate, time to RTS, or level of competition between groups. Compared with traditional BPTB ACLR, additional STA appeared to safely and effectively lead to less subsequent revision ACLR while maintaining acceptable PROMs and objective joint laxity measurements in a young and active patient population. Level III, retrospective cohort study.

Biomechanical Characteristics of Ulnar Collateral Ligament Injuries Treated With and Without Augmentation: A Network Meta-analysis of Controlled Laboratory Studies

Background: Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL. Purpose: To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome). Results: Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], –1.99 N·m; 95% CI, –10.2 to 6.2 N·m; P = .63) compared with the native UCL. UCL reconstruction (Recon) (MD, –12.7 N·m; P < .001) and UCL repair with suture tape augmentation (AugRepair) (MD, –14.8 N·m; P < .001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon (P < .001) and AugRepair (P = .002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, –0.30 to 0.95 N·m/deg; P = .31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, –1.22 to 1.82 mm; P = .70), AugRecon (MD, 0.57 mm; 95% CI, –0.70 to 1.84 mm; P = .38), or Recon (MD, 1.02 mm; 95% CI, –0.02 to 2.05 mm; P = .055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping. Conclusion: AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear.

Ulnar Collateral Ligament Repair With Suture Tape Augmentation: Can You Overtighten?

Background: There has been a renewed interest and, recently, wider implementation of ulnar collateral ligament (UCL) repair in throwing athletes because of improvement in ligament repair technology and corresponding outcome data. Purpose: To compare the biomechanical parameters and failure mode between 2 brace-tightening techniques for UCL repair. Study Design: Controlled laboratory study. Methods: Eleven matched pairs of cadaveric arms were procured. One limb from each pair underwent UCL repair with suture tape augmentation with either (1) attempted restoration of physiologic ligament tension or (2) maximal tension. Each specimen was subjected to 10 cycles of subfailure valgus torque at 90º of flexion in the intact state after UCL avulsion and then after UCL repair. Specimens were then torqued to failure. Articular contact mechanics, linear gap distance, angular displacement, failure torque, failure stiffness, and suture tape pull-through length were recorded. Two-way analysis of variance and paired t tests were used to test for statistical differences. Results: There was a significant effect (P = .01) of tightening on joint contact area. There was a significant decrease in gap distance (P = .03) and angular displacement (P = .004) from the torn condition to the repaired condition for the maximum tension group, without a significant difference in gap distance from the intact condition. Failure torque and stiffness were not significantly different between groups, although there was a significant difference (P = .001) in the overall suture tape pull-through length. Conclusion: Although there are potential physiologic changes at time zero—including significant decreases in contact area, normalized gap distance, and normalized angular displacement with maximal tension repair—examination of failure biomechanics suggests that these effects may be mitigated over time within the construct by suture tape pull-through at the tape-anchor interface. Neither method of UCL repair with suture tape augmentation resulted in overconstraint of the elbow joint compared with the native ligament biomechanics. Clinical Relevance: As more long-term outcome data from UCL repair with suture tape augmentation emerge, there will be wider implementation with various techniques to tension the suture tape. Examining the potential biomechanical sequelae of the UCL repair construct applied under maximal tension will help further refine recommendations for surgeons who utilize this technique for UCL repair.