Andrea Achtnich1, Elmar Herbst2, Philipp Forkel2, Sebastian Metzlaff3, Frederike Sprenker4, Andreas B Imhoff2, Wolf Petersen4. 1. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: a.achtnich@tum.de. 2. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 3. Department of Orthopaedic and Trauma Surgery, St. Joseph Hospital, Berlin, Germany. 4. Department of Orthopaedic and Trauma Surgery, Martin-Luther-Hospital, Berlin, Germany.
Abstract
PURPOSE: To compare clinical and radiologic results of primary anterior cruciate ligament (ACL) suture anchor repair and microfracturing with anatomic ACL single-bundle reconstruction in patients with acute proximal ACL avulsion tears. METHODS: Between January 2010 and December 2013, 420 patients underwent ACL treatment. Forty-one patients were included in this study. The inclusion criteria were as follows: unilateral acute proximal ACL rupture, concomitant meniscus lesions, no previous knee ligament surgery, and no additional ligament injuries or absence of ligament injury of the contralateral knee. Preoperative magnetic resonance imaging confirming a proximal avulsion tear of the ACL was required. Patients had to undergo surgical treatment within 6 weeks after injury. Follow-up examination included Lachman and pivot-shift testing, KT-1000 measurement, and the International Knee Documentation Committee score. RESULTS: At a mean follow-up of 28 months (range, 24 to 31 month), 20 patients in each group were available. A mean KT-1000 arthrometer result of less than 3 mm indicated stability in all patients (P = .269). Three patients had a 1+ Lachman test (P = .072) and 4 patients had a 1+ pivot-shift test in the ACL repair group (P = .342). The International Knee Documentation Committee score results did not differ significantly (P > .99), but there was a significant correlation between poor results and failure rate (P = .001) in the refixation group. The failure rate was 15% in the ACL refixation group and 0% in the reconstruction group (P = .231). Magnetic resonance imaging confirmed homogeneous signal and proper ACL position in 100% of patients in the control group and 86% in the ACL repair group. CONCLUSIONS: Proximal refixation of the ACL using knotless suture anchors and microfracturing restores knee stability and results in comparable functional outcomes to a control group treated with single-bundle ACL reconstruction. The results suggest that refixation of the ACL is a feasible treatment option in selected patients. LEVEL OF EVIDENCE: Level III, case-control study.
PURPOSE: To compare clinical and radiologic results of primary anterior cruciate ligament (ACL) suture anchor repair and microfracturing with anatomic ACL single-bundle reconstruction in patients with acute proximal ACL avulsion tears. METHODS: Between January 2010 and December 2013, 420 patients underwent ACL treatment. Forty-one patients were included in this study. The inclusion criteria were as follows: unilateral acute proximal ACL rupture, concomitant meniscus lesions, no previous knee ligament surgery, and no additional ligament injuries or absence of ligament injury of the contralateral knee. Preoperative magnetic resonance imaging confirming a proximal avulsion tear of the ACL was required. Patients had to undergo surgical treatment within 6 weeks after injury. Follow-up examination included Lachman and pivot-shift testing, KT-1000 measurement, and the International Knee Documentation Committee score. RESULTS: At a mean follow-up of 28 months (range, 24 to 31 month), 20 patients in each group were available. A mean KT-1000 arthrometer result of less than 3 mm indicated stability in all patients (P = .269). Three patients had a 1+ Lachman test (P = .072) and 4 patients had a 1+ pivot-shift test in the ACL repair group (P = .342). The International Knee Documentation Committee score results did not differ significantly (P > .99), but there was a significant correlation between poor results and failure rate (P = .001) in the refixation group. The failure rate was 15% in the ACL refixation group and 0% in the reconstruction group (P = .231). Magnetic resonance imaging confirmed homogeneous signal and proper ACL position in 100% of patients in the control group and 86% in the ACL repair group. CONCLUSIONS: Proximal refixation of the ACL using knotless suture anchors and microfracturing restores knee stability and results in comparable functional outcomes to a control group treated with single-bundle ACL reconstruction. The results suggest that refixation of the ACL is a feasible treatment option in selected patients. LEVEL OF EVIDENCE: Level III, case-control study.
Authors: Patricia M Lutz; Stephanie Geyer; Philipp W Winkler; Markus Irger; Daniel P Berthold; Matthias J Feucht; Andreas B Imhoff; Philipp Forkel Journal: Arch Orthop Trauma Surg Date: 2021-05-19 Impact factor: 3.067