Anterior cruciate ligament repair with internal brace augmentation: A systematic review

• Published in: The knee Vol. 35; pp. 192 - 200
• Main Authors: Wilson, W.T., Hopper, G.P., Banger, M.S., Blyth, M.J.G., Riches, P.E., MacKay, G.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2022
• Subjects: ACL; Adult; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Augmentation; Follow-Up Studies; Humans; Internalbrace; Knee Joint - surgery; Primary; Repair; Suture; Treatment Outcome; Augmentation; ACL; Repair; Primary; Suture; Internalbrace
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2022.03.009

•Proximal ACL tears have the most potential for healing after primary repair.•ACL repair with internal bracing has satisfactory outcomes in individual cohort studies with short to medium term follow-up.•ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4% at mean 2.7 years.•Subjective outcome scores and clinical laxity testing showed satisfactory results in meta-analysis across a total of 347 patients. Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears, augmented with internal bracing from 2014-2021 were included. Primary outcome was failure rate and secondary outcomes were subjective patient reported outcome measures (PROMs) and objective assessment of anteroposterior knee laxity. Nine studies were included, consisting of 347 patients, mean age 32.5 years, mean minimum follow up 2 years. There were 36 failures (10.4%, CI 7.4% - 14.1%). PROMs reporting was variable across studies. KOOS, Lysholm and IKDC scores were most frequently used with mean scores > 87%. The mean Tegner and Marx scores at follow-up were 6.1 and 7.8 respectively. The mean side to side difference measured for anteroposterior knee laxity was 1.2mm. This systematic review with meta-analysis shows that ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4%. Subjective scores and clinical laxity testing also revealed satisfactory results. This suggests that ACL repair with internal bracing should be considered as an alternative to ACL reconstruction for acute proximal tears, with the potential benefits of retained native tissue and proprioception, as well as negating the need for graft harvest.