Summary

We have demonstrated graft reinforcement is a concept which is safe, technically reproducible and may reduce graft failure rates, especially in complex multiligament knee reconstruction.

Abstract

Introduction

We present a novel technique, concept and early results for “graft reinforcement” in knee ligament reconstructive surgery. The graft, be that autograft or allograft, is reinforced with a 2mm width non-biodegradable ultra-high molecular weight polyethylene tape with a terephthalate core and braided polyester jacket (FibreTape, Arthrex, Naples). We also present our current indications for graft reinforcement.

Methods

All patients undergoing reinforced ligament reconstruction (RLR) in the knee at Basingstoke and North Hampshire Hospital between June 2011 and June 2017 were identified from a prospectively maintained database. Skeletally immature patients were excluded. This cohort was interrogated for objective surgical outcomes as well as subjective postoperative scoring indices. We focused on three groups; intra-articular, combined and extra-articular graft reinforcement reconstructions.

Results

A total of 282 patients fulfilled the inclusion criteria. The mean age was 33.5, 33.7 and 42.2 years respectively across the three groups. There were a total of 120 intra articular reinforced ligament reconstructions, of which 107 were ACL reconstructions and 13 PCL reconstructions. Of these, 95 reinforced autografts and 25 reinforced allografts. 17 of the ACL reconstructions were revision procedures. Within this cohort there was an overall 5% complication rate, including a 3.33% (4/120) re-rupture rate. There were an additional 151 cases of combined reinforced intra- and extra-articular ligament reconstructions. Within the combined group, there were 86 reinforced intra-articular ligament reconstructions, 83 of which were ACL and 3 PCL reconstructions. Within the combined cohort there was an overall graft re-rupture rate of 0.66% (1/152). However an overall complication rate of 7.24% (11/152).

We found a statistically significant improvement in all subjective scoring indices post-operatively in the short term (two-year outcomes).

Conclusion

We have demonstrated graft reinforcement is a concept which is safe, technically reproducible and may reduce graft failure rates, especially in complex multiligament knee reconstruction.