Sufian S Ahmad1, Anna J Schreiner2, Michael T Hirschmann3,4, Steffen Schröter2, Stefan Döbele2, Marc D Ahrend2, Ulrich Stöckle2, Atesch Ateschrang2. 1. BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany. sufian@ahmadortho.com. 2. BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany. 3. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. 4. University of Basel, Basel, Switzerland.
Abstract
PURPOSE: It was the aim to assess all published original research dealing with dynamic repair of the anterior cruciate ligament (ACL) and to provide a semi-quantitative analysis of clinical outcome reports. METHODS: Both OVIS and MEDLINE databases were utilized for allocation of articles. All preclinical and clinical studies related to dynamic intraligamentary stabilization (DIS) were identified. Results were tabulated and semi-quantitative analysis performed. RESULTS: Twenty-three articles related to DIS were identified. The predominant level of evidence ranged between II and IV, with only one level I study. Reported failure rates ranged between 4% and 13.6%. Most clinical studies only reported revision rates without referring to failure of restoring stability. Highest success was achieved with proximal ACL ruptures. Both the level of physical activity and patient age have been found to influence the risk of failure. CONCLUSION: There is sufficient evidence to support that DIS repair may be an effective modality for the treatment of acute proximal tears of the ACL. However, comparative studies are lacking. Upcoming studies should compare the technique to ACL reconstruction with failure as an endpoint. Comparison to rigid methods of proximal fixation is also necessary to justify the need for dynamic fixation. Overall, there is evidence to suggest the potential space for ACL repair in the decision tree for individualized treatment planning. The best outcome will be in the hands of the best patient selectors. LEVEL OF EVIDENCE: IV.
PURPOSE: It was the aim to assess all published original research dealing with dynamic repair of the anterior cruciate ligament (ACL) and to provide a semi-quantitative analysis of clinical outcome reports. METHODS: Both OVIS and MEDLINE databases were utilized for allocation of articles. All preclinical and clinical studies related to dynamic intraligamentary stabilization (DIS) were identified. Results were tabulated and semi-quantitative analysis performed. RESULTS: Twenty-three articles related to DIS were identified. The predominant level of evidence ranged between II and IV, with only one level I study. Reported failure rates ranged between 4% and 13.6%. Most clinical studies only reported revision rates without referring to failure of restoring stability. Highest success was achieved with proximal ACL ruptures. Both the level of physical activity and patient age have been found to influence the risk of failure. CONCLUSION: There is sufficient evidence to support that DIS repair may be an effective modality for the treatment of acute proximal tears of the ACL. However, comparative studies are lacking. Upcoming studies should compare the technique to ACL reconstruction with failure as an endpoint. Comparison to rigid methods of proximal fixation is also necessary to justify the need for dynamic fixation. Overall, there is evidence to suggest the potential space for ACL repair in the decision tree for individualized treatment planning. The best outcome will be in the hands of the best patient selectors. LEVEL OF EVIDENCE: IV.
Authors: Christiaan H W Heusdens; Katja Zazulia; Ella Roelant; Lieven Dossche; Damien van Tiggelen; Johan Roeykens; Elke Smits; Johan Vanlauwe; Pieter Van Dyck Journal: BMC Musculoskelet Disord Date: 2019-11-18 Impact factor: 2.362
Authors: Johannes Glasbrenner; Michael J Raschke; Christoph Kittl; Elmar Herbst; Christian Peez; Thorben Briese; Philipp A Michel; Mirco Herbort; Clemens Kösters; Benedikt Schliemann Journal: Am J Sports Med Date: 2022-08-25 Impact factor: 7.010