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Internal Bracing of the Anterior Cruciate Ligament and Posterior Cruciate Ligament with Suture Tape Augmentation

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Lower Extremity Joint Preservation

Abstract

The anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation of the knee, and the posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation of the knee. ACL reconstruction with hamstring or patellar tendon autograft has been the gold standard surgical option for ACL ruptures for many years. Injuries to the PCL in isolation are rare and often managed conservatively although most PCL injuries occur in the multiligament knee injury setting where surgery is indicated, most commonly with a PCL reconstruction. In addition, operative management is indicated in Grade III PCL tears and chronic tears which are symptomatic. ACL and PCL repair techniques have been described in previous literature with variable results. Internal bracing with suture tape augmentation acts as a secondary stabiliser, encouraging natural healing and allowing early mobilisation. This chapter describes internal bracing of the ACL and PCL with suture tape augmentation.

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References

  1. Mackay GM, Blyth MJ, Anthony I, Hopper GP, Ribbans WJ. A review of ligament augmentation with the InternalBrace™: the surgical principle is described for the lateral ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and techniques is presented. Surg Technol Int. 2015;26:239.

    PubMed  Google Scholar 

  2. Regauer M, Mackay G, Lange M, Kammerlander C, Syndesmotic BW. World J Orthop. 2017;8(4):301.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Urch E, DeGiacomo A, Photopoulos CD, Limpisvasti O, ElAttrache NS. Ulnar collateral ligament repair with suture bridge augmentation. Arthrosc Tech. 2018;7(3):e219.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Trofa DP, Lombardi JM, Noticewala MS, Ahmad CS. Ulnar collateral ligament repair with suture augmentation. Arthrosc Tech. 2018;7(1):e53.

    Article  PubMed  Google Scholar 

  5. Coetzee JC, Ellington JK, Ronan JA, Stone RM. Functional results of open Broström ankle ligament repair augmented with a suture tape. Foot Ankle Int. 2018;39(3):304.

    Article  PubMed  Google Scholar 

  6. Acevedo J, Vora A. Anatomical reconstruction of the spring ligament complex: “internal brace” augmentation. Foot Ankle Spec. 2013;6(6):441.

    Article  PubMed  Google Scholar 

  7. Lubowitz JH, MacKay G, Gilmer B. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech. 2014;3(4):e505.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hirahara AM, Mackay G, Andersen WJ. Ultrasound-guided suture tape augmentation and stabilization of the medial collateral ligament. Arthrosc Tech. 2018;7(3):e205.

    Article  PubMed  PubMed Central  Google Scholar 

  9. van der List JP, DiFelice GS. Arthroscopic primary posterior cruciate ligament repair with suture augmentation. Arthrosc Tech. 2017;6(5):e1685.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hopper GP, Mackay GM. Achilles tendon repair using the InternalBrace principle. Surg Technol Int. 2017;30:325.

    PubMed  Google Scholar 

  11. Byrne PA, Hopper GP, Wilson WT, Mackay GM. Knotless repair of achilles tendon rupture in an elite athlete: return to competition in 18 weeks. J Foot Ankle Surg. 2017;56(1):121.

    Article  PubMed  Google Scholar 

  12. Sanchez G, Ferrari MB, Sanchez A, Moatshe G, Chahla J, DePhillipo N, Provencher MT. Proximal patellar tendon repair: internal brace technique with unicortical buttons and suture tape. Arthrosc Tech. 2017;6(2):e491.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Byrne PA, Hopper GP, Wilson WT, Mackay GM. Acromioclavicular joint stabilisation using the internal brace principle. Surg Technol Int. 2018;33:294–8.

    PubMed  Google Scholar 

  14. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980;62(2):259.

    Article  CAS  PubMed  Google Scholar 

  15. Anderson MJ, Browning WM, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med. 2016;4(3):2325967116634074.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50(10):3145.

    Article  CAS  PubMed  Google Scholar 

  17. Leiter JR, Gourlay R, McRae S, de Korompay N, MacDonald PB. Long-term follow-up of ACL reconstruction with hamstring autograft. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):1061.

    PubMed  Google Scholar 

  18. von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63(3):269.

    Article  Google Scholar 

  19. Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42(9):2242.

    Article  PubMed  Google Scholar 

  20. England RL. Repair of the ligaments about the knee. Orthop Clin North Am. 1976;7(1):195.

    CAS  PubMed  Google Scholar 

  21. Weaver JK, Derkash RS, Freeman JR, Kirk RE, Oden RR, Matyas J. Primary knee ligament repair—revisited. Clin Orthop Relat Res. 1985;199:185.

    Google Scholar 

  22. Sherman MF, Bonamo JR. Primary repair of the anterior cruciate ligament. Clin Sports Med. 1988;7(4):739.

    Article  CAS  PubMed  Google Scholar 

  23. Feagin JA, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med. 1976;4(3):95.

    Article  PubMed  Google Scholar 

  24. Lysholm J, Gillquist J, Liljedahl SO. Long-term results after early treatment of knee injuries. Acta Orthop Scand. 1982;53(1):109.

    Article  CAS  PubMed  Google Scholar 

  25. Engebretsen L, Benum P, Sundalsvoll S. Primary suture of the anterior cruciate ligament. A 6-year follow-up of 74 cases. Acta Orthop Scand. 1989;60(5):561.

    Article  CAS  PubMed  Google Scholar 

  26. Engebretsen L, Benum P, Fasting O, Mølster A, Strand T. A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med. 1990;18(6):585.

    Article  CAS  PubMed  Google Scholar 

  27. Andersson C, Odensten M, Gillquist J. Knee function after surgical or nonsurgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with a long-term follow-up period. Clin Orthop Relat Res. 1991;264:255.

    Google Scholar 

  28. Smith PA, Bley JA. Allograft anterior cruciate ligament reconstruction utilizing internal brace augmentation. Arthrosc Tech. 2016;5(5):e1143.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Barrett DS. Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br. 1991;73(5):833.

    Article  CAS  PubMed  Google Scholar 

  30. Co FH, Skinner HB, Cannon WD. Effect of reconstruction of the anterior cruciate ligament on proprioception of the knee and the heel strike transient. J Orthop Res. 1993;11(5):696.

    Article  CAS  PubMed  Google Scholar 

  31. Fridén T, Roberts D, Ageberg E, Waldén M, Zätterström R. Review of knee proprioception and the relation to extremity function after an anterior cruciate ligament rupture. J Orthop Sports Phys Ther. 2001;31(10):567.

    Article  PubMed  Google Scholar 

  32. Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012;40(1):41.

    Article  PubMed  Google Scholar 

  33. Setuain I, Izquierdo M, Idoate F, Bikandi E, Gorostiaga EM, Aagaard P, Cadore EL, Alfaro-Adrián J. Differential effects of 2 rehabilitation programs following anterior cruciate ligament reconstruction. J Sport Rehabil. 2017;26(6):544.

    Article  PubMed  Google Scholar 

  34. Konrath JM, Vertullo CJ, Kennedy BA, Bush HS, Barrett RS, Lloyd DG. Morphologic characteristics and strength of the hamstring muscles remain altered at 2 years after use of a hamstring tendon graft in anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(10):2589.

    Article  PubMed  Google Scholar 

  35. Xie X, Xiao Z, Li Q, Zhu B, Chen J, Chen H, Yang F, Chen Y, Lai Q, Liu X. Increased incidence of osteoarthritis of knee joint after ACL reconstruction with bone-patellar tendon-bone autografts than hamstring autografts: a meta-analysis of 1,443 patients at a minimum of 5 years. Eur J Orthop Surg Traumatol. 2015;25(1):149.

    Article  PubMed  Google Scholar 

  36. Kowalk DL, Duncan JA, McCue FC, Vaughan CL. Anterior cruciate ligament reconstruction and joint dynamics during stair climbing. Med Sci Sports Exerc. 1997;29(11):1406.

    Article  CAS  PubMed  Google Scholar 

  37. Poehling-Monaghan KL, Salem H, Ross KE, Secrist E, Ciccotti MC, Tjoumakaris F, Ciccotti MG, Freedman KB. Long-term outcomes in anterior cruciate ligament reconstruction: a systematic review of patellar tendon versus hamstring autografts. Orthop J Sports Med. 2017;5(6):2325967117709735.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med. 2012;40(3):595.

    Article  PubMed  Google Scholar 

  39. Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, Drogset JO. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med. 2014;42(10):2319.

    Article  PubMed  Google Scholar 

  40. Persson A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, Fevang JM. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004–2012. Am J Sports Med. 2014;42(2):285.

    Article  PubMed  Google Scholar 

  41. Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med. 2012;40(7):1551.

    Article  PubMed  Google Scholar 

  42. Chahla J, Moatshe G, Cinque ME, Dornan GJ, Mitchell JJ, Ridley TJ, LaPrade RF. Single-bundle and double-bundle posterior cruciate ligament reconstructions: a systematic review and meta-analysis of 441 patients at a minimum 2 years’ follow-up. Arthroscopy. 2017;33(11):2066.

    PubMed  Google Scholar 

  43. Belk JW, Kraeutler MJ, Purcell JM, McCarty EC. Autograft versus allograft for posterior cruciate ligament reconstruction: an updated systematic review and meta-analysis. Am J Sports Med. 2017;46(7):1752–7.

    Article  PubMed  Google Scholar 

  44. LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med. 2015;43(12):3077.

    Article  PubMed  Google Scholar 

  45. Smith C, Ajuied A, Wong F, Norris M, Back D, Davies A. The use of the ligament augmentation and reconstruction system (LARS) for posterior cruciate reconstruction. Arthroscopy. 2014;30(1):111.

    Article  PubMed  Google Scholar 

  46. Kannus P, Bergfeld J, Järvinen M, Johnson RJ, Pope M, Renström P, Yasuda K. Injuries to the posterior cruciate ligament of the knee. Sports Med. 1991;12(2):110.

    Article  CAS  PubMed  Google Scholar 

  47. Van de Velde SK, Bingham JT, Gill TJ, Li G. Analysis of tibiofemoral cartilage deformation in the posterior cruciate ligament-deficient knee. J Bone Joint Surg Am. 2009;91(1):167.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lee DY, Park YJ. Single-bundle versus double-bundle posterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials. Knee Surg Relat Res. 2017;29(4):246.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Difelice GS, Lissy M, Haynes P. Surgical technique: when to arthroscopically repair the torn posterior cruciate ligament. Clin Orthop Relat Res. 2012;470(3):861.

    Article  PubMed  Google Scholar 

  50. Pournaras J, Symeonides PP. The results of surgical repair of acute tears of the posterior cruciate ligament. Clin Orthop Relat Res. 1991;267:103.

    Google Scholar 

  51. Strand T, Mølster AO, Engesaeter LB, Raugstad TS, Alho A. Primary repair in posterior cruciate ligament injuries. Acta Orthop Scand. 1984;55(5):545.

    Article  CAS  PubMed  Google Scholar 

  52. Hughston JC, Bowden JA, Andrews JR, Norwood LA. Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg Am. 1980;62(3):438.

    Article  CAS  PubMed  Google Scholar 

  53. Wheatley WB, Martinez AE, Sacks T, Schurhoff MR, Uribe JW, Hechtman KS, Zvijac JE. Arthroscopic posterior cruciate ligament repair. Arthroscopy. 2002;18(7):695.

    Article  PubMed  Google Scholar 

  54. Del Buono A, Radmilovic J, Gargano G, Gatto S, Maffulli N. Augmentation or reconstruction of PCL? A quantitative review. Knee Surg Sports Traumatol Arthrosc. 2013;21(5):1050.

    Article  PubMed  Google Scholar 

  55. Yoon KH, Bae DK, Song SJ, Lim CT. Arthroscopic double-bundle augmentation of posterior cruciate ligament using split Achilles allograft. Arthroscopy. 2005;21(12):1436.

    Article  PubMed  Google Scholar 

  56. Jung YB, Jung HJ, Song KS, Kim JY, Lee HJ, Lee JS. Remnant posterior cruciate ligament-augmenting stent procedure for injuries in the acute or subacute stage. Arthroscopy. 2010;26(2):223.

    Article  PubMed  Google Scholar 

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Acknowledgements

Professor Mackay is a consultant for, and receives royalties from, Arthrex, Inc. Mr. Hopper has no conflict of interest to disclose.

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Correspondence to Graeme P. Hopper .

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Hopper, G.P., Mackay, G.M. (2021). Internal Bracing of the Anterior Cruciate Ligament and Posterior Cruciate Ligament with Suture Tape Augmentation. In: Brittberg, M., Slynarski, K. (eds) Lower Extremity Joint Preservation. Springer, Cham. https://doi.org/10.1007/978-3-030-57382-9_15

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  • DOI: https://doi.org/10.1007/978-3-030-57382-9_15

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