Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis

Blake M Bodendorfer; Evan M Michaelson; Henry T Shu; Nicholas A Apseloff; James D Spratt; Esther C Nolton; Evan H Argintar

doi:10.1016/j.arthro.2019.01.054

Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis

Arthroscopy. 2019 Jul;35(7):2114-2122. doi: 10.1016/j.arthro.2019.01.054. Epub 2019 Jun 2.

Authors

Blake M Bodendorfer¹, Evan M Michaelson², Henry T Shu³, Nicholas A Apseloff², James D Spratt², Esther C Nolton⁴, Evan H Argintar³

Affiliations

¹ Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A.. Electronic address: BlakeBodendorfer@gmail.com.
² Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A.
³ Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, U.S.A.
⁴ Department of Orthopaedic Surgery, Inova Fairfax Hospital, Falls Church, Virginia, U.S.A.

PMID: 31167738
DOI: 10.1016/j.arthro.2019.01.054

Abstract

Purpose: To compare outcomes between standard anterior cruciate ligament reconstruction (ACLR) using hamstring grafts with and without suture augmentation (SA).

Methods: Patients who underwent ACLR with hamstring autografts or allografts with minimum 2-year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index, graft type, and revision status to standard ACLR. Range of motion, pain, postoperative activity, patient-reported outcome measures (PROMs), and complications were collected. Paired 2-tailed Student's t-tests and Pearson's χ²-tests were used for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to preinjury activity level was assessed using Spearman's rho and Pearson's χ²-tests.

Results: Sixty patients at a mean age of 29.50 ± 6.60 years, 43.4% male, body mass index 26.27 ± 3.37, and follow-up of 29.54 ± 5.37 months were included. Preoperative PROMs were not significantly different (P >. 05). Postoperative range of motion was similar between groups (P = .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 < .014). SA predicted improvement in PROMs (P < .05) and maximum pain scores (P = .001). SA was significantly correlated with improved time to return to preinjury activity level (9.17 ± 2.06 vs 12.88 ± 3.94 months; P = .002) and percentage of preinjury activity level (93.33% ± 13.22% vs 83.17% ± 17.69%; P = .010). There was a trend toward improved rate of return to preinjury activity level for SA (76.7% vs 56.7%; P = .100).

Conclusions: Our study demonstrates that SA hamstring ACLRs were associated with improved PROMs, less pain, and a higher percentage of and earlier return to preinjury activity level when compared with standard hamstring ACLRs without evidence of overconstraint.

Level of evidence: Level III, retrospective comparative study.

MeSH terms

Adolescent
Adult
Allografts
Anterior Cruciate Ligament Reconstruction / methods*
Arthralgia / physiopathology
Autografts
Female
Follow-Up Studies
Hamstring Tendons / transplantation*
Humans
Knee Joint / physiopathology
Male
Matched-Pair Analysis
Middle Aged
Pain Measurement
Patient Reported Outcome Measures
Range of Motion, Articular / physiology
Retrospective Studies
Sutures*
Young Adult