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Hamstring Autograft Anterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without
Chad W Parkes1, Devin P Leland1, Bruce A Levy1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Insights
Adding suture tape reinforcement to hamstring autograft anterior cruciate ligament reconstruction (ACLR) is safe and does not increase complications. This technique shows similar patient-reported outcomes and graft failure rates compared to standard ACLR.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Anterior cruciate ligament (ACL) reconstruction (ACLR) is a common orthopedic procedure.
- Hamstring autografts are frequently used for ACLR.
- Suture tape reinforcement is a potential adjunct to enhance graft stability.
Purpose of the Study:
- To compare complication rates, graft failure, and patient-reported outcomes (PROs) after hamstring autograft ACLR with and without suture tape reinforcement.
- To evaluate the safety and efficacy of independent suture tape reinforcement in ACLR.
Main Methods:
- A 1:2 matched-cohort study compared 36 patients with suture tape reinforcement to 72 control patients.
- Patients were matched for age, sex, BMI, preinjury activity score, and meniscal injury.
- Data collected included demographics, reoperations, graft failures, and PROs (Tegner, Lysholm, IKDC) at minimum 2-year follow-up.
Main Results:
- Reoperation rates were 14% in both the suture tape and control groups.
- Graft failure occurred in 1 patient (2.8%) with suture tape and 4 patients (5.6%) in the control group.
- No significant differences were found in return-to-sport rates or IKDC/Lysholm scores; however, the suture tape group showed a significantly higher postoperative Tegner activity score (P=.026).
Conclusions:
- Hamstring autograft ACLR with independent suture tape reinforcement is a safe procedure.
- This technique demonstrated comparable complication, graft failure, and PROs to standard ACLR.
- Suture tape reinforcement may potentially improve return to higher activity levels.
Purpose:
To compare the (1) rates of complications and reoperations, (2) rate of anterior cruciate ligament (ACL) graft failure, and (3) patient-reported outcomes (PROs) among patients after hamstring autograft ACL reconstruction (ACLR) with and without independent suture tape reinforcement at a minimum 2-year clinical follow-up.
Methods:
We performed a 1:2 matched-cohort comparison of patients who underwent hamstring autograft ACLR with and without independent suture tape reinforcement between July 2011 and July 2017. Patients were matched according to age, sex, body mass index, preinjury Tegner activity score, and concomitant meniscal injury. Medical records were reviewed for demographic characteristics, additional injuries, and concomitant procedures. PRO scores (including Tegner activity, Lysholm, and International Knee Documentation Committee scores) and physical examination findings were collected both preoperatively and at a minimum of 2 years postoperatively.
Results:
Overall, 108 patients who underwent ACLR were included: 36 patients (mean age, 25.3 years; range, 13-44 years) with independent suture tape reinforcement and 72 patients (mean age, 24.9 years; range, 13-54 years) without suture tape reinforcement. Overall, 5 of 36 suture tape patients (14%) and 10 of 72 control patients (14%) underwent reoperations. At an average follow-up of 26.1 months in the suture tape cohort and 31.3 months in the control cohort, 1 patient in the suture tape cohort and 4 patients in the control cohort experienced graft failure. There were no statistically significant differences between the suture tape and control groups regarding return-to-sport rate (89% and 88%, respectively), postoperative International Knee Documentation Committee score (94.4 and 93.8, respectively), and postoperative Lysholm score (95.6 and 94, respectively). There was a statistically significant difference between the suture tape and control groups in postoperative Tegner activity score, at 7.1 (95% confidence interval, 6.5-7.6) and 6.4 (95% confidence interval, 6.2-6.6), respectively (P = .026).
Conclusions:
ACLR with hamstring autograft and independent suture tape reinforcement was performed safely with low rates of complications, graft failure, and reoperations with similar PROs, function, and return-to-sport rates when compared with hamstring autograft ACLR without suture tape reinforcement at a minimum 2-year follow-up.
Level Of Evidence:
Level III, retrospective comparative study.
