No difference in laxity, proprioception and neuromuscular control after suture-tape augmented ACL repair of acute proximal avulsions versus ACL reconstruction using hamstring autografts in young, active population

Abstract

Purpose: The purpose of this study is to compare results of suture-tape augmented anterior cruciate ligament (ACL) repair (internal bracing [IB]) and ACL reconstruction (ACLR) with hamstring autograft in terms of laxity, proprioception and neuromuscular control. The hypothesis was that with strict indications IB may provide better results in proprioception and neuromuscular control.

Methods: Patients with unilateral ACL injury treated with IB or ACLR with hamstring autograft were enroled in this retrospective study. Anterior tibial translation (ATT) in 30° and 90° of flexion was measured with Rolimeter. The joint position sense (JPS) test was performed in 30° and 60° of flexion using Biodex System 4Pro. The time-synchronized motion capture system and surface electromyography set were used during dynamic tasks to assess knee valgus and semitendinosus (ST) and biceps femoris (BF) activities. Comparisons between both techniques and operated versus contralateral healthy knees were performed.

Results: The study groups involved 28 patients after ACLR (21.8 ± 4.8 years) and 20 patients after IB (25.8 ± 10.5 years) with the average follow-up 30 ± 18 and 28 ± 15 months, respectively. The ATT did not differ significantly between operated groups. In 30° of flexion ATT for ACLR was significantly higher in operated than in contralateral knee (5.8 ± 2.4 mm vs. 4.3 ± 1.3 mm, p < 0.001). The JPS test and dynamic knee valgus presented no significant differences. The ACLR group presented significantly higher ST (p = 0.048) and BF (p = 0.012) activity comparing operated to contralateral knee in dynamic tasks.

Conclusion: Suture-tape augmented ACL repair and ACLR with hamstring autograft yield similar results in terms of laxity, proprioception and neuromuscular control.

Level of evidence: Level III: Retrospective comparative study.

Keywords: anterior cruciate ligament reconstruction; anterior cruciate ligament repair; internal bracing; neuromuscular control; proprioception; suture tape augmentation.

Figure 1

The joint position sense test performed with Biodex System 4PRO. The starting position is 95° of hip and 90° of knee flexion (a). The mean reproduction error is assessed in 60° (b) and 30° (c) of knee flexion.

Figure 2

Forward landing task. Participant starts standing on 35 cm box (a) and is instructed to jump off the box, land on two feet (b) and immediately perform a vertical jump (c). Dynamic knee valgus, semitendinosus and biceps femoris activity are assessed.