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

Abstract

Background: 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.

Purpose/hypothesis: 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.

Study design: Cohort study; Level of evidence, 3.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: ACLR; quadrupled semitendinosus hamstring autograft; revision; suture tape augmentation.

Figure 1.

Overhead view of the femoral adjustable loop device demonstrating the suture tape (asterisk) looped through the femoral button to remain separate from the adjustable loop device (white arrow) through which the graft was passed. Black arrow, blue passing suture.

Figure 2.

Flowchart detailing included and excluded patients. ACLR, anterior cruciate ligament reconstruction; ALL, anterolateral ligament; HTA, hamstring tendon autograft; QST, quadrupled semitendinosus; STA, suture tape augmentation.

Figure 3.

Kaplan-Meier survival plot depicting a 4-year graft survival between the suture tape augmentation (STA) group (blue line) and the control group (red line). Each step-off represents a graft failure. Comparison between groups was performed using the Wald test.