Suture-augmented primary anterior cruciate ligament repair with internal brace shows acceptable re-rupture rates, favourable outcomes and high return-to-sport rates: A systematic review.

PURPOSE: To describe the safety, efficacy and clinical outcomes of suture-augmented primary anterior cruciate ligament (ACL) repair with internal bracing.

METHODS

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; the protocol was registered in the PROSPERO database (registration number: CRD42024573962). A comprehensive search of the PubMed, Embase and Cochrane Library databases up to August 2024 was conducted to identify studies reporting clinical outcomes of suture-augmented ACL repair. Inclusion criteria were a minimum follow-up of 2 years, reporting of re-rupture rates together with complications, or functional outcome scores such as International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm or Tegner activity scale.

RESULTS

Thirteen studies involving 671 patients met the eligibility criteria and were included. The ACL re-rupture rate was 10.6% (95% confidence interval [CI]: 7.4-14.2), and the rate of reoperations unrelated to ACL re-rupture (primarily for hardware removal) was 3.2% (95% CI: 0.9-6.5). The pooled data showed a mean time to reinjury of 1.2 years (95% CI: 1-1.3), and failure occurred at a mean patient age of 19.8 years (95% CI: 14.8-24.8). The mean return to sport was 9.5 months (95% CI: 5.7-13.3). Patient-reported outcome measures included IKDC with a post-operative mean score of 86.9 (95% CI: 83.6-90.1) and KOOS total score of 85 (95% CI: 82.1-88). KT-1000 laxity measurements revealed a mean side-to-side difference of 0.9 mm (95% CI: 0.5-1.3).

CONCLUSION

Suture-augmented primary ACL repair with internal brace shows acceptable clinical results, encouraging functional recovery and re-rupture rates. Internal bracing is not associated with a high rate of complications, suggesting that the technique is safe and appropriate for use in carefully selected patients. However, heterogeneity in the existing studies means that additional high-quality, long-term comparative studies are needed to clarify the indications and reliability of this procedure.

LEVEL OF EVIDENCE: Level IV, systematic review of studies with LoE I-IV.