2025 ISAKOS Biennial Congress Paper
Repair with Suture Tape Augmentation Shows a Higher Failure Rate Compared to Reconstruction for Anterior Cruciate Ligament Tears: A Systematic Review and Meta-Analysis
Rodrigo Conde, MS ARGENTINA
André Richard Da Silva Oliveira Filho, Student, Joao Pessoa, Paraiba BRAZIL
Elcio Machinski, md BRAZIL
Vinícius Furtado, Student, Londrina, Paraná BRAZIL
Bruno Butturi Varone, MD, Sao Paulo BRAZIL
Riccardo Gomes Gobbi, MD, PhD, São Paulo, SP BRAZIL
Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Daniel Leal, MD, São Paulo, SP BRAZIL
Fundación HA Barceló, Buenos Aires, Buenos Aires, BRAZIL
FDA Status Cleared
Summary
ACL-STA vs. ACL-R for ACL tears
Abstract
Background
Interest in preserving and repairing ruptured anterior cruciate ligaments (ACL) has resurged in recent years. Among the emerging repair techniques is suture tape augmentation (ACL-STA). To date, no meta-analysis has directly compared this technique to the gold standard, ACL reconstruction (ACL-R).
Purpose
Perform a systematic review and meta-analysis to evaluate whether ACL-STA offers functional benefits and fewer complications compared to ACL-R in patients with ACL tear.
Methods
The meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, EMBASE and Cochrane Central for studies that directly compared ACL-STA to ACL-R. The main endpoints of interest were patients reported outcomes (PROs) and rate of failure. Muscle and joint functions and surgery time was also assessed. Statistical analysis was performed by Review Manager 5.1.7. Heterogeneity was assessed with I² statistics.
Results
A total of 9 studies comprising 1,049 patients were included; 381 (36.3%) underwent ACL-STA. Hamstring autografts were used for ACL-R in 421 patients (63.0%). Most studies (6 out of 8) reported the endpoints for longer-term (≥2 year) follow-up. The failure rate was higher for patients undergoing ACL-STA (risk ratio 3.62; 95% CI 1.16 to 11.33; p=0.03; I2: 52%). Mostly, there was no significant difference between groups for the PROs. The only exception was KOOS Symptoms, that was significantly improved following ACL-STA (mean difference 2.49; 95% CI 0.05 to 4.92; p=0.05; I2: 0%). The hamstring muscles was significantly stronger following ACL-STA (mean difference 11.99%; 95% CI 4.47% to 19.51%; p=0.002; I2: 73%). No significant difference was found in anterior tibial translation and quadriceps strength.
Conclusions
The findings revealed that ACL-STA had a higher failure rate compared to ACL-R. However, ACL-STA demonstrated improved hamstring strength and KOOS symptom scores. No statistically significant differences were observed in other patient-reported outcomes, time to return to sports, quadriceps strength and anterior tibial translation.