2017 ISAKOS Biennial Congress ePoster #1100

 

ACL Reconstruction Using Short Hamstrings Autograft and Tape-Locking Screw Fixation: 1-Year Results

Adam M. Katchky, MD, MSc, BESc, FRCSC, Welland, ON CANADA
Esther Gambero-Barrero, BSc, DNP, Brisbane, QLD AUSTRALIA
Kelly A. Macgroarty, MBBS, FRACS(Orth), Brisbane, QLD AUSTRALIA

Brisbane Knee and Shoulder Clinic, Brisbane, Queensland, AUSTRALIA

FDA Status Cleared

Summary

Patient-reported outcomes were assessed up to 1 year following ACL reconstruction using the Tape-Locking Screw (TLS®) system, revealing significant improvements from the pre-operative baseline status and high rates of return to activity at or near the pre-injury level.

Abstract

Introduction

Anterior cruciate ligament (ACL) rupture is a common injury among athletes and active individuals, and rates of ACL reconstruction are continuing to rise with increasing sports participation among many groups. Numerous techniques for ACL reconstruction have been described, including variations in graft material, preparation and fixation, and controversy exists regarding the optimal technique. The Tape-Locking Screw (TLS®) System (FH Orthopaedics, Mulhouse, France) is a novel method of ACL reconstruction, using a single autograft hamstrings tendon to form a short, 4- or 5-stranded graft which is fixed in place using a tape-screw interface. Benefits include a thicker and stronger graft, stronger graft fixation, sparing of an additional hamstring tendon, and the ability to pursue an accelerated rehabilitation protocol, encouraging earlier return to work and sport. Early studies have been very promising, however they have largely focused on biomechanical outcomes and short term follow-up.

AIMS: To assess patient-centered clinical outcomes at 1-year following ACL reconstruction using the TLS® system.

Methods

Clinical charts were reviewed for all patients who have undergone TLS® ACL reconstruction within a single orthopaedic practice. Patients were identified who had a primary isolated ACL reconstruction and had completed 1-year follow up. Data extraction included KOOS, KOOS-SP, WOMAC, Lysholm and Tegner collected pre-operatively and at 6- and 12-months post-op. Patients also reported Global Rating of Change (GROC) at 1-year post-op.

Results

188 patients were identified who have undergone TLS® ACL reconstruction in this practice since 2014. Of these, 58 had completed 1-year follow-up. These include 46 with isolated primary ACL reconstruction, 1 with concomitant meniscus repair, 8 with concomitant ligament repair or reconstruction, and 3 who underwent revision ACL reconstruction. At one year following isolated primary ACL reconstruction, significant improvements were seen in all patient-reported outcome measures (mean change = KOOS symptoms 36.3; KOOS pain 34; KOOS ADL 30; KOOS Sport 70.4; KOOS QOL 49.1; KOOS-PS 33; WOMAC Pain 4.3; WOMAC Movement 2.4; WOMAC Function 20.4; WOMAC Total 27.2; Lysholm 51). Apart from WOMAC pain and movement subscales, all of these improvements were considered to be both statistically and clinically significant, each being considerably greater than the minimal clinically important difference established for each outcome measure. 83% of patients returned to activities at or near their baseline (change in Tegner = -2 or greater), with 50% returning at or above their pre-injury level (change in Tegner = 0 or greater). Median GROC at 1 year was 6, on a scale from -7 to 7. There were 3 complications – 1 graft failure (2.1%), 1 patient with symptomatic tibial screw (2.1%) which was removed, and 1 patient with anterior knee pain.

Conclusions

The TLS® system represents a safe and effective technique for ACL reconstruction with 1-year patient-reported and return to sport outcomes similar to or better than existing cohorts reported in the literature. Further study is planned to establish longer-term outcomes in a larger patient cohort.