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Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis

      Purpose

      To compare outcomes between standard anterior cruciate ligament reconstruction (ACLR) using hamstring grafts with and without suture augmentation (SA).

      Methods

      Patients who underwent ACLR with hamstring autografts or allografts with minimum 2-year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index, graft type, and revision status to standard ACLR. Range of motion, pain, postoperative activity, patient-reported outcome measures (PROMs), and complications were collected. Paired 2-tailed Student's t-tests and Pearson's χ2-tests were used for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to preinjury activity level was assessed using Spearman's rho and Pearson's χ2-tests.

      Results

      Sixty patients at a mean age of 29.50 ± 6.60 years, 43.4% male, body mass index 26.27 ± 3.37, and follow-up of 29.54 ± 5.37 months were included. Preoperative PROMs were not significantly different (P >. 05). Postoperative range of motion was similar between groups (P = .457). Postoperative average daily (0.60 ± 1.25 vs 1.66 ± 1.90) and maximum daily pain (1.57 ± 1.83 vs 3.35 ± 2.28) were significantly lower for SA (P < .014). SA predicted improvement in PROMs (P < .05) and maximum pain scores (P = .001). SA was significantly correlated with improved time to return to preinjury activity level (9.17 ± 2.06 vs 12.88 ± 3.94 months; P = .002) and percentage of preinjury activity level (93.33% ± 13.22% vs 83.17% ± 17.69%; P = .010). There was a trend toward improved rate of return to preinjury activity level for SA (76.7% vs 56.7%; P = .100).

      Conclusions

      Our study demonstrates that SA hamstring ACLRs were associated with improved PROMs, less pain, and a higher percentage of and earlier return to preinjury activity level when compared with standard hamstring ACLRs without evidence of overconstraint.

      Level of Evidence

      Level III, retrospective comparative study.
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      Linked Article

      • Editorial Commentary: Anterior Cruciate Ligament Graft Reinforcement: A New Era Supported by Science
        ArthroscopyVol. 35Issue 7
        • Preview
          The use of suture tape for soft tissue reinforcement during anterior cruciate ligament surgery is amassing science from translational models to bench biomechanical studies and now clinical outcomes. Suture tape reinforcement is not a synthetic ligament replacement. The primary goal of adding suture tape is for anterior cruciate ligament graft protection during the healing and remodeling phase, especially in young, active patients, to minimize the risk of graft retears. Accepting new techniques requires critical review of available science, as well as an inherent belief that there always is a better way.
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