Short-term follow-up of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring autograft with suture tape reinforcement as an internal brace.

INTRODUCTION

Suture tape augmentation with high-strength sutures, also known as internal bracing (IB), has been proposed as a 'safety belt' to protect the graft during the ligamentization period and decrease the chances of graft failure following anterior cruciate ligament reconstruction (ACLR). The primary objective of this study is to compare the functional outcome of arthroscopic ACLR with and without IB. The secondary aim is to compare complications, including arthrofibrosis, joint stiffness, synovitis, effusions, and ACL reinjury that require revision.

METHODS

A retrospective cohort study was conducted, comparing 60 patients equally divided into two groups who underwent primary ACLR with semitendinosus (ST) autograft (30 patients) and without internal bracing (30 patients), with a 2-year follow-up of preoperative and postoperative patient-reported outcomes (PROs) using the Lysholm Scale (LYSHOLM), Knee injury and Osteoarthritis Outcome score (KOOS), International Knee Documentation Committee (IKDC), and Single Assessment Numeric Evaluation (SANE) scores.

RESULTS

The pre-op LYSHOLM, KOOS, IKDC, and SANE scores showed no statistically significant difference among the groups. After comparing the postoperative scores, the SANE score showed a statistically significant difference; patients who underwent ACLR with IB reported a slight improvement in SANE scores, with a median of 95 (90-100) as compared to that of ACLR alone, a median of 90 (80-95), showing a statistical significance (p-value = 0.012). The other postoperative PRO scores showed no significant difference. Complications such as postoperative joint stiffness, synovitis, infection, and graft failure requiring revision surgery were absent in both groups.

CONCLUSION

When comparing the outcomes of ACLR using quadrupled ST autograft with and without internal bracing, after a minimum 2-year follow-up, none of the patients experienced any problems, graft failure, or required reoperation. Additionally, the patients had identical PROs, function, and rates of returning to sports. Therefore, it can be inferred that ACLR with internal bracing is a safe and secure surgical technique; however, more trials of extended length are required to assess potential consequences, such as arthrofibrosis, synovitis, graft failure, and infection.

LEVEL OF EVIDENCE: IV.