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. 2021 Aug 31;10(17):3948.
doi: 10.3390/jcm10173948.

The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction-A Retrospective Study

Dawid Szwedowski  1 , Łukasz Paczesny  2 , Jan Zabrzyński  2   3 , Maciej Gagat  4 , Marcin Domżalski  5 , Gazi Huri  6 , Wojciech Widuchowski  7
Affiliations

The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction-A Retrospective Study

Dawid Szwedowski et al. J Clin Med. .

Abstract

Background: The current standard of treatment of anterior cruciate ligament (ACL) is reconstruction (ACLR). This technique has some disadvantages: poor proprioception, donor site morbidity and the inability to restore joint kinematics. ACL repair could be an alternative treatment. The purpose of the study was to compare the stability and the function after ACL primary repair versus single-bundle ACLR.

Methods: In a retrospective study, 12 patients underwent primary ACL repair with internal bracing, 15 patients underwent standard ACLR. Follow-up examinations were evaluated at up to 2 years postoperatively. One patient in the ACL repair group was lost to follow-up due to re-rupture. The absolute value of anterior tibial translation (ATT) and the side-to-side difference in the same patient (ΔATT) were evaluated using the GNRB arthrometer. The Lysholm knee scoring was obtained. Re-ruptures and other complications were recorded.

Results: Anterior tibial translation (ATT) was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137). Arthrometric measurements demonstrated a mean side-to-side difference (ΔATT) 1.87 (range 0.2 to 4.9) mm significantly decreased compared to ACLR 3.36 (range 1.2-5.6 mm; p = 0.0107). The mean Lysholm score was 85.3 points in the ACL repair group and 89.9 in ACLR group. No significant differences between ACL repair and ACLR were found for the Lysholm score. There was no association between AP laxity and clinical outcomes. There were two complications in the internal bracing group: one patient had re-rupture and was treated by ACLR, another had limited extension and had arthroscopic debridement.

Conclusions: Anterior tibial translation was significantly decreased after ACL repair. Additionally, the functional results after ACL repair with internal bracing were comparable with those after ACLR. It should be noted that the two complications occurred. The current study supports further development of ACL repair techniques.

Keywords: anterior cruciate ligament (ACL); internal bracing; knee laxity; primary ACL repair.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flowchart presenting the study design.
Figure 2
Figure 2
(a) Fresh ACL rupture. Stump (S) is waving in front of the intercondylar notch of the femur (F). (b) The stump (S) is sutured by means of the closed-loop FiberLink sutures and retracted from the femoral bone (F). (c) After preparation of the femoral tunnel the stump (S) is repositioned to meet native insertion on the femur (F). Next, the tibial tunnel is drilled. The drill tip is visible in the center of the stump (arrow). (d) After completion of the procedure, the tension of the repaired ACL (arrowheads) and FiberTape is checked and a full range of motion confirmed.
Figure 3
Figure 3
The patient was lying on a standard examination table in the supine position with the arms placed along the body, each knee being comparatively tested, the healthy knees are investigated first. The lower limb is placed in rigid adjustable leg support, with the knee placed at 0° of rotation. The knee should be placed so that the inferior pole of the patella corresponds to the lower border of the patellar support, the joint line is palpated and should be located between the support and the jack.
Figure 4
Figure 4
Box plot of assessments of anterior tibial translation (ATT) comparing the difference between ACL repair and ACLR group. ATT was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137).
Figure 5
Figure 5
Box plot of assessments of side-to-side difference (ΔATT) in ACL repair and ACLR group. It demonstrates a mean side-to-side difference 1.87 (range 0.2 to 4.9) mm in ACL repair significantly decreased compared to ACLR 3.36 (range 1.2 to 5.6 mm; p = 0.0107).
Figure 6
Figure 6
Box plot of Lysholm score assessments comparing ACL repair and ACLR group. The mean Lysholm score after 12 months was 89.2 (range: 57–100) in the internal bracing cohort and 89.9 (range: 67–100) in the ACLR group. There were no statistically significant differences between both groups (p = 0.9793).
Figure 7
Figure 7
(a) Primary ACL repair. Distal stump (dS) is waving in front of the intercondylar notch of the femur (F). Proximal stump (pS) is visible. (b) The stump is sutured by two closed-loop FiberLink sutures and retracted from the femoral bone (F). (c) After completion of the procedure, the tension of the repaired ACL (arrowheads) and FiberTape is checked. (d) Revision surgery. Re-rupture of the construct is visible with gap (G) opening. Distal stump is folding and hook traction reveals FiberLink sutures (arrow).
Figure 8
Figure 8
(a) Primary ACL repair. Distal stump (dS) waving in front of the intercondylar notch of the femur (F) with a gap (G) opening after retraction by suturing instrument (I). (b) Proximal stump (pS) drilled (arrow). Distal stump (dS) was retracted at this stage. (c) After completion of the procedure, the tension of the repaired ACL (arrowheads) and FiberTape was confirmed. (d) Second look surgery due to poor range of motion. After scaring tissue removal physiological tension of the healed ACL was confirmed by hook (H) traction.
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