Summary

This study demonstrates comparable rates of secondary surgery when comparing traditional ACL reconstruction with hamstring autograft to ACL repair with suture tape augmentation. Therefore, ACL repair with suture tape augmentation should be considered a safe and reliable alternative to ACL reconstruction in cases of acute proximal ACL ruptures.

Abstract

Anterior cruciate ligament (ACL) graft rupture and contralateral ACL injury following ACL reconstruction are worrying complications for patients. Ipsilateral re-injury rates vary in the literature but have been reported to be as high as 32% in young patients. Additionally, contralateral ACL injuries have been reported to be up to 20% in younger patients and subsequent meniscal surgery following ACL reconstruction has been reported to be up to 10%. The aim of this study was to determine the frequency of secondary surgery following ACL repair with suture tape augmentation in comparison to conventional hamstring ACL reconstructions. We hypothesized that there would be no differences between the two groups.

Between September 2011 and April 2018, 273 patients with an ACL rupture underwent ACL reconstruction using hamstring autograft. In the same timeframe, 137 patients with an acute proximal ACL rupture underwent ACL repair with suture tape augmentation. Inclusion criteria for ACL repair were acute proximal tears with adequate ACL tissue quality. Patients with mid-substance, distal ACL ruptures and retracted ACL remnants were not suitable for ACL repair. Patients who had multiligament injuries or surgery to the anterolateral ligament were excluded from these cohorts. Secondary surgery was identified by contacting the patients by email/telephone and reviewing patient notes at the time of this analysis. Information recorded were basic demographics, ipsilateral graft rupture, contralateral ACL rupture, secondary meniscal surgery and any other further surgery on the ipsilateral or contralateral knee. Mean follow-up was 58.7 months (range, 24-103).

There was 1 patient lost to follow-up in the ACL reconstruction group leaving 272 patients (99.6%) for the final analysis. In the ACL repair group, 3 patients were lost to follow-up leaving 134 patents (97.8%) for the final analysis. Re-rupture occurred in 32 patients (11.8%) in the ACL reconstruction group compared to 22 patients (16.4%) in the ACL repair group (p=0.194). Contralateral ACL rupture occurred in 4 patients (1.5%) in the ACL reconstruction group compared to 3 patients (2.2%) in the ACL repair group (p=0.224). In the ACL reconstruction group 9 patients (3.3%) required meniscal surgery whilst 5 patients (3.7%) required meniscal surgery in the ACL repair group (p=0.830). There were 7 (2.6%) other operations performed in the ACL reconstruction group compared to 3 other operations (2.2%) in the ACL repair group (p=0.374). The overall number of patients undergoing secondary surgery in the ACL reconstruction group was 52 (19.1%) in comparison to 30 (22.4%) in the ACL repair group (p=0.114).

The results of this study confirm the rates of secondary surgery in patients undergoing ACL reconstruction reported in other studies. Moreover, it demonstrates comparable rates of secondary surgery with ACL repair with suture tape augmentation. Therefore, ACL repair with suture tape augmentation should be considered a safe and reliable alternative to ACL reconstruction in cases of acute proximal ACL ruptures with the added benefits of avoiding graft harvest and retaining the proprioceptive fibers of the native ACL.