Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 25; no. 12; pp. 3923 - 3928
• Main Authors: Krismer, Anna M., Gousopoulos, Lampros, Kohl, Sandro, Ateschrang, Atesch, Kohlhof, Hendrik, Ahmad, Sufian S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Anterior cruciate ligament; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Child; Cyclic loads; Deformation; Failure; Female; Healing; Humans; Joint Instability - prevention & control; Knee; Male; Medicine; Medicine & Public Health; Orthopedics; Patients; Range of Motion, Articular; Regression analysis; Regression models; Reoperation; Repair; Risk analysis; Risk factors; Rupture; Rupture - surgery; Rupturing; Shielding; Stability; Success; Treatment Outcome; Young Adult; Predictive factors; Anterior cruciate ligament (ACL); Rerupture; Dynamic intraligamentary stabilisation (DIS)
• DOI: 10.1007/s00167-017-4445-6
• ISSN: 0942-2056

Purpose Primary repair of the anterior cruciate ligament (ACL) has regained interest of clinicians with recent development of novel repair techniques. Dynamic intraligamentary stabilisation was introduced in an attempt to promote healing by shielding cyclic loads acting upon the ACL during the healing phase. The aim of this study was to identify negative factors likely to influence success of this procedure. Methods Between 2009 and 2014, 264 patients with an acute ACL rupture undergoing dynamic intraligamentary stabilisation were included in this study. Patients were evaluated for anterior/posterior laxity; range of motion and patient reported outcome measures. Adverse events and re-operations were noted. Failure was defined as AP Translation >3 mm, re-rupture or conversion to ACL reconstruction. Minimum follow-up was 24 months. Univariate and multivariate regression models were utilized to determine predictors of failure. Results An overall complication rate of 15.1% was noted comprising 9.5% ( n = 25) re-ruptures, 4.1% ( n = 11) persistent instability, and 1.5% ( n = 4) > 10° fixed flexion deformity. Two factors were identified as negative predictors of failure: (1) pursuit of competitive sport activities with a Tegner pre-injury score >7 (Odds Ratio (OR) 4.4, CI 1.2–15.9, p = 0.02) and (2) mid-substance ACL rupture location (OR 2.5, 1.1–5.7, p = 0.02). When neither of those risk factors occurred the failure rate was limited to 3.9%. Conclusions Correct patient selection and narrowing of indications are necessary to maintain high success rates of the procedure. Mid-substance ACL ruptures and a high pre-injury sports activity level are two predictors of inferior outcome. Level of evidence II.