Summary

In this matched cohort analysis comparing suture augmented and standard anterior cruciate ligament reconstruction, patients who underwent suture augmented reconstructions had superior patient-reported outcome measures, less pain, and higher percentage of and earlier return to pre-injury activity.

Abstract

Introduction

Suture augmented anterior cruciate ligament reconstruction (ACLR) has become a popular method, but little comparative data to standard reconstruction has been reported in the literature. We sought to compare standard and suture augmented ACLR, with the hypothesis that patients undergoing suture augmented ACLR would have earlier return to play and similar patient-reported outcome measures.

Methods

Patients who underwent ACLR with hamstring grafts with minimum 2 year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index (BMI), and revision status to standard ACLR. Range of motion (ROM), pain, postoperative activity, patient-reported outcome measures (PROMs), subjective knee scores, and complications were collected. Paired 2-tailed Student’s t-tests and Pearson’s chi-squared tests were utilized for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to pre-injury activity level was assessed using Spearman’s rho and Pearson’s chi-squared tests.

Results

60 patients at a mean age of 29.50±6.60 years, 43.4% male, BMI 26.27±3.37 and follow-up of 29.54±5.37 months were included. Preoperative PROMs were not significantly different (P>.05). Patients in both groups experienced significant improvements in maximum daily pain and PROMs (P<.05). Postoperative ROM was similar between groups (P=0.457). Postoperative average daily (0.60±1.25 vs. 1.66±1.90) and maximum daily pain (1.57±1.83 vs. 3.35±2.28) were significantly lower for SA (P<0.014). Postoperative Knee Injury and Osteoarthritis Outcome Sports/Rec and knee-related Quality of Life, Western Ontario and McMaster Universities Osteoarthritis Index, International Knee Documentation Committee, and subjective knee scores were superior for SA (P<0.05). SA predicted improvement in PROMs and maximum pain scores (P=0.001). SA was significantly correlated with improved time to return to pre-injury activity level (9.17±2.06 vs. 12.88±3.94 months, P=0.002) and percentage of pre-injury activity level (93.33±13.22% vs. 83.17±17.69%, P=0.010). There was a trend toward improved rate of return to pre-injury activity level for SA (76.7% vs. 56.7%, P=0.100).

Conclusion

ACLR with SA was associated with superior PROMs, less pain, and a higher percentage of and earlier return to pre-injury activity with similar ROM. Longer-term studies are necessary.