Title : Arthroscopic ACL reconstruction using quadrupled hamstring autograft with internal brace: Our Cost-effective technique and short-term outcomes of comparison without internal bracing
Abstract:
Background: Suture tape augmentation with high-strength sutures, also known as internal bracing (IB), has been proposed as a ‘safety belt’ to protect the graft during the ligamentisation period and decrease the chances of graft failure following anterior cruciate ligament reconstruction (ACLR).The primary objective of this study is to compare the functional outcome of arthroscopic ACLR with and without IB. The secondary objective is to compare complications, including arthrofibrosis, joint stiffness, synovitis, effusions, and ACL re-injury that require revision.
Methods: A retrospective cohort study was conducted, comparing 60 patients equally divided into two groups who underwent primary ACLR with and without internal bracing (30 patients), with a 2-year follow-up of pre-operative and post-operative patient-reported outcomes (PROs) using Lysholm Scale (LYSHOLM), Knee injury and Osteoarthritis Outcome score (KOOS), International Knee Documentation Committee (IKDC), and Single Assessment Numeric Evaluation (SANE) scores.
Results: The pre-operative Lysholm, KOOS, IKDC, and SANE scores showed no statistically significant difference between the groups. After comparing the post-operative scores, the SANE score showed a statistically significant difference; patients who underwent ACLR with IB reported a slight improvement in SANE scores, with a median of 95 (90 - 100), as compared to ACLR alone, with a median of 90 (80 - 95), showing a statistical significance (p-value = 0.012). The other post-operative PRO scores showed no significant difference. Complications were absent in both groups.
Conclusion: After a minimum 2-year follow-up, comparison of ACLR outcomes using quadrupled semitendinosus autografts with and without internal bracing showed that none experienced any problems, graft failure, or required reoperation. Additionally, the patients had identical patient-reported outcomes (PROs) and function. Therefore, it can be inferred that ACLR with Internal bracing is a safe and secure surgical technique; however, more trials with extended follow-up are required to assess potential complications, including arthrofibrosis, synovitis, graft failure, and infection.
