Summary

The aim of this systematic review and meta-analysis is to compare the long-term clinical outcomes of augmented ACL repair against primary ACL repair without augmentation.

Abstract

Purpose

The consensus gold-standard surgical treatment of anterior cruciate ligament (ACL) rupture is arthroscopic reconstruction. There has been a renewed interest in primary repair, and in particular, augmented repairs of the ACL. The aim of this systematic review and meta-analysis is to compare the long-term clinical outcomes of augmented ACL repair against primary ACL repair without augmentation.

Materials/Methods:
As per PRISMA guidelines, 11 studies comparing functional outcomes of augmented repair against primary repair in Cochrane, Embase, PubMed and Scopus were identified. Clinical outcomes included were (1) number of revisions, (2) incidence of osteoarthritis (Ahlbäck Classification), (3) pivot shift test, (4) Lachman test (5) KT-1000 arthrometer.

Results

We found that patients undergoing augmented ACL repair were less likely to undergo subsequent revision surgery, as compared to primary ACL repair (Risk Ratio=0.42; 95% CI: 0.27-0.65; p<0.05).

In terms of clinical stability, a positive pivot shift test was less likely to be found in augmented repair versus primary repair (RR=0.69, 95% CI: 0.56-0.85, p<0.05). Grade 1+ Lachman test was also less likely to be found in augmented repair (RR=0.83, 95% CI: 0.69-1.00, p<0.05). More significantly, a Grade 2+ and 3+ Lachman test was less prevalent in augmented repair group (RR=0.61, 95% CI: 0.41-0.91, p<0.05), compared to primary repair. Instrumented laxity testing via KT-1000 arthrometer also provided similar results for ligamentous stability, favoring the augmented group (RR=0.64, 95% CI: 0.48-0.84, p<0.05) over primary repair. Amongst two studies that published the radiological grades of osteoarthritis during post-operative follow up, the incidence of osteoarthritis was found to be higher in primary repair group, as compared to augmented repair (RR=0.33, 95% CI: 0.13-0.85, p<0.05).

Conclusion

Augmented ACL repair, compared to primary repair, has superior clinical outcomes in terms of lower revision rates, higher ligamentous stability, and lower incidence of secondary osteoarthritis.