Suture-Augmented ACL Repair for Proximal Avulsion or High-Grade Partial Tears Shows Similar Side-to-Side Difference and No Clinical Differences at 2 Years Versus Conventional ACL Reconstruction for Near-Complete and Mid-Substance Tears or Poor ACL Tissue Quality.

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Citation: Arthroscopy. 2023 Jul 19PMID: 37479153Institution: MedStar National Rehabilitation Network | MedStar Washington Hospital CenterDepartment: Lafayette Sports Medicine Center | MedStar Georgetown University Hospital/MedStar Washington Hospital Center | Orthopaedic Surgery ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXED | Year: 2023ISSN:
  • 0749-8063
Name of journal: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy AssociationAbstract: CONCLUSIONS: At 2 years postoperatively, KT-1000 testing showed less than 1 mm side-to-side difference and no differences were observed between the groups in the percentage of patients who met or exceeded the MCID. Significantly higher early patient-reported outcome scores were found with SAACLR versus CACLR. The rerupture rate between the groups was not significantly different. Copyright © 2023. Published by Elsevier Inc.METHODS: In this non-randomized, prospective study, 30 patients underwent SAACLR for proximal ACL avulsion or high-grade partial ACL tear (Sherman grade 1 or 2) and 30 patients underwent CACLR for proximal one-third/distal two-thirds junction tears and mid-substance tears (Sherman grade 3 or 4) tear types by one surgeon between 2018 and 2020. Failure was defined as ACL reinjury. Outcome measures were KT-1000 for side-to-side knee laxity evaluation, Visual Analog Scale (VAS) for pain, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Severity Score (KOOS), Tegner Activity Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm Knee Scoring Scale, and Single Assessment Numeric Evaluation (SANE). Minimal clinically important difference (MCID) was calculated for IKDC and KOOS subscores.PURPOSE: To compare objective and subjective clinical outcomes between suture-augmented anterior cruciate ligament repair (SAACLR) and conventional ACL reconstruction (CACLR) with minimum 2-year follow-up.RESULTS: Three failures (10%) occurred in the SAACLR group, with no failures in the CACLR group (P = 0.24). A total of 23 (85%) SAACLR patients and 27 (90%) CACLR patients had patient-reported outcomes and physical examination at minimum 2 years. Two-year KT-1000 testing with 20 lbs showed less than 1 mm side-to-side difference between the groups. No significant differences in the percentage of patients meeting the MCID were found between the SAACLR and CACLR groups at 2 years: IKDC, 10.81 (82%) versus 10.54 (93%) (P=0.48); KOOS Pain, 11.55 (73%) versus 10.58 (78%) (P=0.94); KOOS Symptoms, 8.15 (77%) versus 10.32 (74%) (P=1.0); KOOS ADL 12.19 (59%) versus 12.28 (70%) (P=0.60); 18.99 (71%) versus 16.77 (86%) (P=0.42). Significantly higher IKDC scores were observed with SAACLR versus CACLR at 3 months (p=0.01) and 6 months (p=0.02), and significantly higher Lysholm scale, Tegner Activity Scale, and all KOOS subscale scores were observed at 6 months.All authors: Apseloff NA, Douoguih WA, Kelly RL, Murray JC, Svoboda SJFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2023-08-15
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CONCLUSIONS: At 2 years postoperatively, KT-1000 testing showed less than 1 mm side-to-side difference and no differences were observed between the groups in the percentage of patients who met or exceeded the MCID. Significantly higher early patient-reported outcome scores were found with SAACLR versus CACLR. The rerupture rate between the groups was not significantly different. Copyright © 2023. Published by Elsevier Inc.

METHODS: In this non-randomized, prospective study, 30 patients underwent SAACLR for proximal ACL avulsion or high-grade partial ACL tear (Sherman grade 1 or 2) and 30 patients underwent CACLR for proximal one-third/distal two-thirds junction tears and mid-substance tears (Sherman grade 3 or 4) tear types by one surgeon between 2018 and 2020. Failure was defined as ACL reinjury. Outcome measures were KT-1000 for side-to-side knee laxity evaluation, Visual Analog Scale (VAS) for pain, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Severity Score (KOOS), Tegner Activity Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm Knee Scoring Scale, and Single Assessment Numeric Evaluation (SANE). Minimal clinically important difference (MCID) was calculated for IKDC and KOOS subscores.

PURPOSE: To compare objective and subjective clinical outcomes between suture-augmented anterior cruciate ligament repair (SAACLR) and conventional ACL reconstruction (CACLR) with minimum 2-year follow-up.

RESULTS: Three failures (10%) occurred in the SAACLR group, with no failures in the CACLR group (P = 0.24). A total of 23 (85%) SAACLR patients and 27 (90%) CACLR patients had patient-reported outcomes and physical examination at minimum 2 years. Two-year KT-1000 testing with 20 lbs showed less than 1 mm side-to-side difference between the groups. No significant differences in the percentage of patients meeting the MCID were found between the SAACLR and CACLR groups at 2 years: IKDC, 10.81 (82%) versus 10.54 (93%) (P=0.48); KOOS Pain, 11.55 (73%) versus 10.58 (78%) (P=0.94); KOOS Symptoms, 8.15 (77%) versus 10.32 (74%) (P=1.0); KOOS ADL 12.19 (59%) versus 12.28 (70%) (P=0.60); 18.99 (71%) versus 16.77 (86%) (P=0.42). Significantly higher IKDC scores were observed with SAACLR versus CACLR at 3 months (p=0.01) and 6 months (p=0.02), and significantly higher Lysholm scale, Tegner Activity Scale, and all KOOS subscale scores were observed at 6 months.

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