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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2018

01-02-2018 | Knee

ACL suturing using dynamic intraligamentary stabilisation showing good clinical outcome but a high reoperation rate: a retrospective independent study

Authors: Martin Meister, Jonathan Koch, Felix Amsler, Markus P. Arnold, Michael T. Hirschmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2018

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Abstract

Purpose

Most of the clinical outcome studies dealing with ACL repair are from the developer’s perspective. It is a fact that these developer-initiated studies tend to interpret the results rather in favour than against their developed technique or product. Hence, it was the purpose of the present independent investigator-initiated study to investigate the clinical and radiological outcomes as well as failure rate of patients who underwent an ACL suture using dynamic intraligamentary stabilisation device in a specialised independent knee clinic.

Methods

A retrospective study was performed on prospectively collected data of 26 patients (28 ± 9 years, range 18–50 years; male/female = 17:9) who underwent biologically augmented ACL suture using dynamic intraligamentary stabilisation. Mean time from ACL injury was 15 ± 5 days (range 4–25 days). In addition, in seven (27%) patients a medial meniscus refixation and in four (15%) patients a lateral meniscus refixation was done for associated meniscal lesions. All patients were clinically and radiologically followed up at 6 weeks, 3 and 12 months after ACL surgery using the Tegner and Lysholm score as well as IKDC score. Adverse events such as ACL failure, arthrofibrosis, pain > 3 on a visual analogue scale as well as the need and type of revision surgery were noted.

Results

Four patients (15%) suffered from an ACL retear due to another adequate trauma during follow-up time. In six patients (23%), an arthrofibrosis (extension deficit of > 10° or flexion deficit > 20°) was noted. In five of those six patients, an arthroscopic arthrolysis was performed. Three patients also complained about pain VAS > 3. In nine (35%) patients, superfluous ACL scar tissue and the DIS device including the polyethylene suture and the DIS screw were removed, and in another two (8%) patients, the DIS screw only was removed. In two patients, a partial meniscectomy was performed due to a non-healed meniscal suture. The median Tegner score was 8 (range 6–10) before injury and 7 (range 3–10) at last follow-up (p < 0.001). The mean Lysholm score before surgery was 28 ± 14 and 94 ± 11 at last follow-up (p < 0.001). At last follow-up, 14 patients (66%) showed a normal total IKDC score (A) and 4 patients (19%) were nearly normal (B) and 2 patients (10%) were slightly abnormal (C) and one patient (5%) was entirely abnormal (p < 0.001).

Conclusion

ACL suturing using the dynamic intraligamentary stabilisation device showed satisfying clinical results at 12-month follow-up. However, a retear rate of 15% and a reoperation rate of 35% due to retear or arthrofibrosis appear rather high. These results highlight the importance of adequate patient selection and the delicacy of the surgical procedure.

Level of evidence

Retrospective case series, Level IV.

Literature
  1. Buchler L, Regli D, Evangelopoulos DS, Bieri K, Ahmad SS, Krismer A, Muller T, Kohl S (2016) Functional recovery following primary ACL repair with dynamic intraligamentary stabilization. Knee 23(3):549–553View ArticlePubMed
  2. Eggli S, Kohlhof H, Zumstein M, Henle P, Hartel M, Evangelopoulos DS, Bonel H, Kohl S (2015) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23(4):1215–1221View ArticlePubMed
  3. Eggli S, Roder C, Perler G, Henle P (2016) Five year results of the first ten ACL patients treated with dynamic intraligamentary stabilisation. BMC Musculoskelet Disord 17:105View ArticlePubMedPubMed Central
  4. Ekhtiari S, Horner NS, de Sa D, Simunovic N, Hirschmann MT, Ogilvie R, Berardelli RL, Whelan DB, Ayeni OR (2017) Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-017-4482-1
  5. Feagin JA Jr., Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4(3):95–100View ArticlePubMed
  6. Fleming BC, Carey JL, Spindler KP, Murray MM (2008) Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res 26(11):1500–1505View ArticlePubMedPubMed Central
  7. Haberli J, Henle P, Acklin YP, Zderic I, Gueorguiev B (2016) Knee joint kinematics with dynamic augmentation of primary anterior cruciate ligament repair—a biomechanical study. J Exp Orthop 3(1):29View ArticlePubMedPubMed Central
  8. Henle P, Bieri KS, Brand M, Aghayev E, Bettfuehr J, Haeberli J, Kess M, Eggli S (2017) Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-017-4574-y
  9. Inokuchi T, Matsumoto T, Takayama K, Nakano N, Zhang S, Araki D, Matsushita T, Kuroda R (2017) Influence of the injury-to-surgery interval on the healing potential of human anterior cruciate ligament-derived cells. Am J Sports Med 45(6):1359–1369View ArticlePubMed
  10. Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H, Eggli S (2014) A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study. Knee 21(2):477–480View ArticlePubMed
  11. Kohl S, Evangelopoulos DS, Kohlhof H, Hartel M, Bonel H, Henle P, von Rechenberg B, Eggli S (2013) Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique. Knee Surg Sports Traumatol Arthrosc 21(3):599–605View ArticlePubMed
  12. Kohl S, Stock A, Ahmad SS, Zumstein M, Keel M, Exadaktylos A, Kohlhof H, Eggli S, Evangelopoulos DS (2015) Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury 46(4):724–728View ArticlePubMed
  13. Krismer AM, Gousopoulos L, Kohl S, Ateschrang A, Kohlhof H, Ahmad SS (2017) Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-017-4445-6
  14. Murray MM (2009) Current status and potential of primary ACL repair. Clin Sports Med 28(1):51–61View ArticlePubMedPubMed Central
  15. Murray MM, Palmer M, Abreu E, Spindler KP, Zurakowski D, Fleming BC (2009) Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skeletally immature animals: an in vivo study. J Orthop Res 27(5):639–645View ArticlePubMedPubMed Central
  16. O’Donoghue DH (1950) Surgical treatment of fresh injuries to the major ligaments of the knee. J Bone Joint Surg Am 32(A:4):721–738View ArticlePubMed
  17. Proffen BL, Perrone GS, Roberts G, Murray MM (2015) Bridge-enhanced ACL repair: a review of the science and the pathway through FDA investigational device approval. Ann Biomed Eng 43(3):805–818View ArticlePubMedPubMed Central
  18. Schliemann B, Glasbrenner J, Rosenbaum D, Lammers K, Herbort M, Domnick C, Raschke MJ, Kosters C (2017) Changes in gait pattern and early functional results after ACL repair are comparable to those of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-017-4618-3
  19. Smith JO, Yasen SK, Palmer HC, Lord BR, Britton EM, Wilson AJ (2016) Paediatric ACL repair reinforced with temporary internal bracing. Knee Surg Sports Traumatol Arthrosc 24(6):1845–1851View ArticlePubMed
  20. van der List JP, DiFelice GS (2017) Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament. Knee 24(4):798–807View ArticlePubMed
  21. Vavken P, Murray MM (2011) The potential for primary repair of the ACL. Sports Med Arthrosc 19(1):44–49View ArticlePubMedPubMed Central
Metadata
Title
ACL suturing using dynamic intraligamentary stabilisation showing good clinical outcome but a high reoperation rate: a retrospective independent study
Authors
Martin Meister
Jonathan Koch
Felix Amsler
Markus P. Arnold
Michael T. Hirschmann
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4726-0

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