Two-year follow-up of postcommercialisation cohort of 100 bridge-enhanced anterior cruciate ligament restorations shows low retear rate and good patient-reported outcomes.

PURPOSE: To review adverse events and outcomes 2 years postoperatively from the Bridge Enhanced anterior cruciate ligament (ACL) Restoration (BEAR) procedure in the first 100 subjects of the Bridge registry, a postcommercialisation prospective cohort.

METHODS

Technique modifications (repair and bridging suture type, femoral and tibial fixation), adverse events and reoperations were recorded. Physical examinations were reported at 0, 6, 9 and 12 months and patient-reported outcomes (International Knee Documentation Committee, knee injury and osteoarthritis outcome score, Marx, return to sport index) were reported at 0, 6, 9, 12 and 24 months. Adverse events were compared between the original and modified technique groups using Fisher's Exact test. Paired t-tests were used to compare patient-reported outcomes at 1 and 2 years.

RESULTS

Mean follow-up was 22.3 ± 5.5 months, range 3-32.7 months, with five subjects exiting early. Mean age was 31.8 ± 14.3 years (range 7.7-69.6). Sixty-seven per cent were female. Fifty-five underwent a BEAR procedure using the original technique, while 45 had a modified surgical technique. The overall rates of adverse events with reoperations at 2 years included: two ACL retears with meniscus injury, two ACL retears without meniscus injury, two contralateral tears, five meniscus injuries without ACL retear (one medial, three lateral, one both medial and lateral), two manipulations under anaesthesia, one lysis of adhesions/cyclops removal and four removals of retained suture. Overall reoperation rate was 18.9% (17/90) at 2 years (28.0% with original technique, 7.5% with modified technique; p = 0.02) with 5.6% (5/90) ipsilateral ACL retear rate. There were no significant differences in ACL retear rates between the original technique and modified technique groups. From 1 to 2 years, there were statistically significant improvements in IKDC and three of the five KOOS scales.

CONCLUSION

The rates of ACL retear status post BEAR with and without modification are low at 2 years, with five retears occurring between 14 and 28 months. Excellent stability and range of motion are attained at 1 year, with good patient reported outcomes measures at 2 years.

LEVEL OF EVIDENCE: Level II, cohort study.