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, 20 (1), 547

Study Protocol: A Single-Blind, Multi-Center, Randomized Controlled Trial Comparing Dynamic Intraligamentary Stabilization, Internal Brace Ligament Augmentation and Reconstruction in Individuals With an Acute Anterior Cruciate Ligament Rupture: LIBRƎ Study

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Study Protocol: A Single-Blind, Multi-Center, Randomized Controlled Trial Comparing Dynamic Intraligamentary Stabilization, Internal Brace Ligament Augmentation and Reconstruction in Individuals With an Acute Anterior Cruciate Ligament Rupture: LIBRƎ Study

Christiaan H W Heusdens et al. BMC Musculoskelet Disord.

Abstract

Background: The current gold standard for the treatment of an anterior cruciate ligament (ACL) rupture is reconstruction with tendon graft. Recently, two surgical ACL repair techniques have been developed for treating an acute ACL rupture: Dynamic Intraligamentary Stabilization (DIS, Ligamys®) and Internal Brace Ligament Augmentation (IBLA, InternalBrace™). We will conduct a single-blind, multi-center, randomized controlled trial which compares DIS, IBLA and reconstruction for relative clinical efficacy and economic benefit.

Methods: Subjects, aged 18-50 years, with a proximal, primary and repairable ACL rupture will be included. DIS is preferably performed within 4 weeks post-rupture, IBLA within 12 weeks and reconstruction after 4 weeks post-rupture. Patients are included in study 1 if they present within 0-4 weeks post-rupture and surgery is feasible within 4 weeks post-rupture. Patients of study 1 will be randomized to either DIS or IBLA. Patients are included in study 2 if they present after 4 weeks post-rupture and surgery is feasible between 5 and 12 weeks post-rupture. Patients of study 2 will be randomized to either IBLA or reconstruction. A total of 96 patients will be included, with 48 patients per study and 24 patients per study arm. Patients will be followed-up for 2 years. The primary outcome is change from baseline (pre-rupture) in International Knee Documentation Committee score to 6 months post-operatively. The main secondary outcomes are the EQ-5D-5 L, Tegner score, Lysholm score, Lachman test, isokinetic and proprioceptive measurements, magnetic resonance imaging outcome, return to work and sports, and re-rupture/failure rates. The statistical analysis will be based on the intention-to-treat principle. The economic impact of the surgery techniques will be evaluated by the cost-utility analysis. The LIBRƎ study is to be conducted between 2018 and 2022.

Discussion: This LIBRƎ study protocol is the first study to compare DIS, IBLA and ACL reconstruction for relative clinical efficacy and economic benefit. The outcomes of this study will provide data which could aid orthopaedic surgeons to choose between the different treatment options for the surgical treatment of an acute ACL rupture.

Trial registration: This study is registered at ClinicalTrials.gov; NCT03441295. Date registered 13.02.2018.

Keywords: Acute anterior cruciate ligament rupture; Anterior cruciate ligament; Anterior cruciate ligament injury; Anterior cruciate ligament reconstruction; Anterior cruciate ligament repair; Knee; Orthopaedics.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram: screening, inclusion, surgery and follow-up. *Depends on when the patient presents at the consultation desk after the ACL rupture. **Patients in the exploratory group will be replaced, but are still part of the study. ACL = Anterior Cruciate Ligament, DIS = Dynamic Intraligamentary Stabilization, IBLA = Internal Brace Ligament Augmentation, MRI = Magnetic Resonance Imaging
Fig. 2
Fig. 2
Three-digit ACL rupture classification. The first digit describes the ACL rupture location: ‘A’ for proximal third, ‘B’ for central third and ‘C’ for distal third. The second digit is the ACL rupture status: ‘1’ for 1 bundle, ‘2’ for 2 bundles and ‘3’ for multilacerated. The third digit describes the ACL synovial tube: ‘1’ for completely intact, ‘2’ for ≥50% intact and ‘3’ for < 50% intact [17]
Fig. 3
Fig. 3
ACL reconstruction, left knee, frontal view,©Mathys Ltd. Bettlach. Permission was granted by the company©Mathys Ltd. Bettlach to use this picture in a journal article
Fig. 4
Fig. 4
Ligamys® technique, left knee, frontal view. Picture can be found in the ‘Ligamys® Surgical technique’ brochure,©Mathys Ltd. Bettlach. Permission was granted by the company©Mathys Ltd. Bettlach to use this picture in a journal article
Fig. 5
Fig. 5
InternalBrace™ technique, left knee, frontal view. Picture can be found in the ‘ACL Primary Repair with InternalBrace™ Surgical technique’ brochure,©Arthrex GmbH. Permission was granted by the company©Arthrex GmbH to use this picture in a journal article

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