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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2023

13-10-2023 | KNEE

There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta-analysis

Authors: Qian Man, Yitian Gao, Hangle Wang, Yong Ma, Qingyang Meng

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

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Abstract

Purpose

This study aims to determine the efficacy of anterior cruciate ligament reconstruction (ACLR) using autograft combined with or without ligament augmentation.

Methods

A computerized search of the databases was conducted, including PubMed, Web of Science, Embase, Scopus and the Cochrane Library. Only prospective or retrospective comparative studies with a minimum 2-year follow-up were considered for inclusion. Two independent reviewers performed data extraction and methodological quality assessment. A Mantel–Haenszel analysis was used for the pooling of results. Sensitivity analysis was performed to maintain the stability of results. The egger test was applied to assess the publication bias.

Results

Fourteen studies were included. The total cohort was 1353 patients (non-augmented group: 763 patients; augmented group: 590 patients). There were three Randomized Controlled Trials (RCTs, Level I), six retrospective comparative studies (Level III) and five case–control studies (Level III). The follow-up rate was ≥ 88% and the follow-up periods were ≥ 24 months in all included studies. The augmented graft used to compare with autograft included the Ligament Augmentation Device (LAD), the Ligament Advanced Reinforcement System (LARS) artificial ligament, FiberTape, hamstring tendon allograft, degradable poly (urethane urea). No significant differences were observed between the augmented and non-augmented groups regarding postoperative patient-reported outcomes (PROs), including the International Knee Documentation Committee score, Lysholm score and Tegner score, knee laxity, including KT-1000, side-to-side difference, Lachman test and pivot shift and rate of graft failure.

Conclusions

ACLR using autografts combined with ligament augmentation shows no advantages in PROs, knee laxity and graft failure rate compared with using autografts only.

Level of evidence

Level III.

Trial registration

The research protocol was registered at the PROSPERO database (CRD42022324784).
Appendix
Available only for authorised users
Literature
1.
Allom RJ, Wood JA, Chen DB, MacDessi SJ (2022) The addition of suture tape to the hamstring graft construct does not reduce instrumented knee laxity following ACL reconstruction. Arthrosc Sports Med Rehabil 4:e545–e551CrossRefPubMed
2.
Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606CrossRefPubMed
3.
Aujla RS, Ebert JR, Annear PT (2021) Anterior cruciate ligament reconstruction using autologous hamstrings augmented with the ligament augmentation and reconstruction system versus hamstrings alone: a comparative cohort study. Orthop J Sports Med 9:23259671211046630CrossRefPubMedPubMedCentral
4.
Bachmaier S, Smith PA, Bley J, Wijdicks CA (2018) Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: a biomechanical full construct model. Arthroscopy 34:490–499CrossRefPubMed
5.
Barrett GR, Field LD (1993) Comparison of patella tendon versus patella tendon/Kennedy ligament augmentation device for anterior cruciate ligament reconstruction: study of results, morbidity, and complications. Arthroscopy 9:624–632CrossRefPubMed
6.
Bodendorfer BM (2021) Editorial commentary: the anterior cruciate ligament may be safer wearing a suture tape augmentation seat belt: click it or ticket. Arthroscopy 37:3344–3346CrossRefPubMed
7.
Bodendorfer BM, Michaelson EM, Shu HT, Apseloff NA, Spratt JD, Nolton EC et al (2019) Suture augmented versus standard anterior cruciate ligament reconstruction: a matched comparative analysis. Arthroscopy 35:2114–2122CrossRefPubMed
8.
Mackenzie EA, Huntington LS, Tulloch S (2022) Suture tape augmentation of anterior cruciate ligament reconstruction increases biomechanical stability: a scoping review of biomechanical, animal, and clinical studies. Arthroscopy 38:2073–2089CrossRef
9.
Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP et al (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 10:Ed00142
10.
Diermeier T, Rothrauff BB, Engebretsen L, Lynch AD, Ayeni OR, Paterno MV et al (2020) Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc 28:2390–2402CrossRefPubMedPubMedCentral
11.
Drogset JO, Grontvedt T (2002) Anterior cruciate ligament reconstruction with and without a ligament augmentation device—results at 8-year follow-up. Am J Sports Med 30:851–856CrossRefPubMed
12.
Ebert JR, Nairn R, Breidahl W, Annear PT (2021) Double-bundle anterior cruciate ligament reconstruction using autologous hamstrings with LARS augmentation demonstrates comparable outcomes to hamstrings alone, without evidence of synovitis or early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 30(7):2320–2328CrossRefPubMed
13.
Elveos MM, Drogset JO, Engebretsen L, Brønn R, Lundemo TO, Gifstad T (2018) Anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft with and without a ligament augmentation device: a 25-year follow-up of a prospective randomized controlled trial. Orthop J Sports Med 6:2325967118808778CrossRefPubMedPubMedCentral
14.
Firth AD, Bryant DM, Litchfield R et al (2022) Predictors of graft failure in young active patients undergoing hamstring autograft anterior cruciate ligament reconstruction with or without a lateral extra-articular tenodesis: the stability experience. Am J Sports Med 50(2):384–395CrossRefPubMedPubMedCentral
15.
Hamido F, Al Harran H, Al Misfer AR, El Khadrawe T, Morsy MG, Talaat A et al (2015) Augmented short undersized hamstring tendon graft with LARS® artificial ligament versus four-strand hamstring tendon in anterior cruciate ligament reconstruction: preliminary results. Orthop Traumatol Surg Res 101:535–538CrossRefPubMed
16.
Heusdens CHW, Blockhuys K, Roelant E, Dossche L, Van Glabbeek F, Van Dyck P (2021) Suture tape augmentation ACL repair, stable knee, and favorable PROMs, but a re-rupture rate of 11% within 2 years. Knee Surg Sports Traumatol Arthrosc 29:3706–3714CrossRefPubMed
17.
Hoogeslag RAG, Brouwer RW, Boer BC, de Vries AJ, Huis In’t Veld R (2019) Acute anterior cruciate ligament rupture: repair or reconstruction? Two-year results of a randomized controlled clinical trial. Am J Sports Med 47:567–577CrossRefPubMed
18.
Itoh S, Muneta T, Shinomiya K, Ichinose S (1999) Electron microscopic evaluation of the effects of stress-shielding on maturation of the mid-substance and ligament-bone junction of the reconstructed anterior cruciate ligament in rabbits. J Mater Sci Mater Med 10:185–190CrossRefPubMed
19.
Jacobs CA, Burnham JM, Makhni E, Malempati CS, Swart E, Johnson DL (2017) Allograft augmentation of hamstring autograft for younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 45:892–899CrossRefPubMed
20.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMed
21.
22.
Kitchen BT, Mitchell BC, Cognetti DJ, Siow MY, Howard R, Carroll AN et al (2022) Outcomes after hamstring ACL reconstruction with suture tape reinforcement in adolescent athletes. Orthop J Sports Med 10:23259671221085576CrossRefPubMedPubMedCentral
23.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100CrossRefPubMedPubMedCentral
24.
Lindanger L, Strand T, Mølster AO, Solheim E, Fischer-Bredenbeck C, Ousdal OT et al (2022) Predictors of osteoarthritis development at a median 25 years after anterior cruciate ligament reconstruction using a patellar tendon autograft. Am J Sports Med 50:1195–1204CrossRefPubMed
25.
Matava MJ, Koscso J, Melara L, Bogunovic L (2021) Suture tape augmentation improves the biomechanical performance of bone-patellar tendon-bone grafts used for anterior cruciate ligament reconstruction. Arthroscopy 37:3335–3343CrossRefPubMed
26.
27.
Ménétrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16:224–231CrossRefPubMed
28.
Millan SM, Thorn D, Ford E (2021) A novel approach to augmenting allograft hamstring anterior cruciate ligament reconstructions utilizing a resorbable type I collagen matrix with platelet rich plasma. Case Rep Orthop 2021:5574676PubMedPubMedCentral
29.
Muren O, Dahlstedt L, Dalen N (2003) Reconstruction of acute anterior cruciate ligament injuries: a prospective, randomised study of 40 patients with 7-year follow-up—no advantage of synthetic augmentation compared to a traditional patellar tendon graft. Arch Orthop Trauma Surg 123:144–147CrossRefPubMed
30.
Noonan BC, Bachmaier S, Wijdicks CA, Bedi A (2020) Independent suture tape reinforcement of tripled smaller-diameter and quadrupled grafts for anterior cruciate ligament reconstruction with tibial screw fixation: a biomechanical full construct model. Arthroscopy 36:481–489CrossRefPubMed
31.
Parkes CW, Leland DP, Levy BA, Stuart MJ, Camp CL, Saris DBF et al (2021) Hamstring autograft anterior cruciate ligament reconstruction using an all-inside technique with and without independent suture tape reinforcement. Arthroscopy 37:609–616CrossRefPubMed
32.
Perkins CA, Busch MT, Christino M, Herzog MM, Willimon SC (2019) Allograft augmentation of hamstring anterior cruciate ligament autografts is associated with increased graft failure in children and adolescents. Am J Sports Med 47:1576–1582CrossRefPubMed
33.
Peterson L, Eklund U, Engström B, Forssblad M, Saartok T, Valentin A (2014) Long-term results of a randomized study on anterior cruciate ligament reconstruction with or without a synthetic degradable augmentation device to support the autograft. Knee Surg Sports Traumatol Arthrosc 22:2109–2120CrossRefPubMed
34.
Rao AJ, Macknet DM, Stuhlman CR, Yeatts NC, Trofa DP, Odum SM et al (2021) Allograft augmentation of hamstring autograft in anterior cruciate ligament reconstruction results in equivalent outcomes to autograft alone. Arthroscopy 37:173-182.e172CrossRefPubMed
35.
36.
Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA et al (2016) Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 44:1502–1507CrossRefPubMed
37.
Santi MD, Richardson AB (1994) The ligament augmentation device in hamstring grafts for reconstruction of the anterior cruciate ligament. Am J Sports Med 22:524–530CrossRefPubMed
38.
Smith PA (2021) Editorial commentary: repair the anterior cruciate ligament when you can: add suture tape augmentation and dress for success. Arthroscopy 37:1242–1244CrossRefPubMed
39.
Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed
40.
Thuresson P, Sandberg R, Johansson O, Balkfors B, Westlin N (1996) Anterior cruciate ligament reconstruction with the patellar tendon—augmentation or not? A 2-year follow-up of 82 patients. Scand J Med Sci Sports 6:247–254CrossRefPubMed
41.
Tiefenboeck TM, Thurmaier E, Tiefenboeck MM, Ostermann RC, Joestl J, Winnisch M et al (2015) Clinical and functional outcome after anterior cruciate ligament reconstruction using the LARS™ system at a minimum follow-up of 10 years. Knee 22:565–568CrossRefPubMed
42.
Torres SJ, Nelson TJ, Pham N, Uffmann W, Limpisvasti O, Metzger MF (2022) Suture tape augmentation increases the time-zero stiffness and strength of anterior cruciate ligament grafts: a cadaveric study. Arthrosc Sports Med Rehabil 4(4):e1253–e1259CrossRefPubMedPubMedCentral
43.
Metadata
Title
There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta-analysis
Authors
Qian Man
Yitian Gao
Hangle Wang
Yong Ma
Qingyang Meng
Publication date
13-10-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07605-7

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