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Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Dynamic intraligamentary stabilization (DIS) is recognized as a ligament preserving technique for the treatment of acute anterior cruciate ligament (ACL) injuries. The aim of this study was to assess the integrity and morphology of the recovered ACL after DIS repair.

Methods

The cohort comprised 47 patients with an acute proximal ACL rupture undergoing DIS repair. All patients underwent diagnostic arthroscopy after a minimum postoperative interval of 6 months for semi-quantitative evaluation of ACL integrity, function and scar tissue formation. Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores as well as objective anteroposterior (ap) translation were assessed at 6 weeks, 3-, 6-  and 12 months postoperatively.

Results

Full restoration of the ACL volume was affirmed in 30 (63.8%) patients and two-third restoration in 13 (27.7%). Hypertrophic scar formation was observed in 23 (48.9%) patients. Forty-four patients (93.6%) demonstrated sufficient ACL tensioning intraoperatively upon anterior stress. At final follow-up, the median Tegner activity level was 5.5 (3–10), Lysholm and IKDC scores were 100 (64–100) and 94 (55–100) points, respectively. The mean ap-translation differed from the normal knee by 2.1 ± 2.2 mm. Deficient ACL recovery was noted in four patients (8.5%), none of which required secondary reconstructive surgery.

Conclusion

The results demonstrate that clinical recovery of ACL function after DIS repair is resultant to both restoration of ACL volume and scar tissue formation. Factors influencing the degree of scar tissue formation need further investigation to enable future attempts of guiding a balanced biological healing response.

Level of evidence

IV.

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Authors and Affiliations

  1. BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany

    Atesch Ateschrang, Ulrich Stöckle, Steffen Schroeter & Marc Daniel Ahrend

  2. Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland

    Sufian S. Ahmad

  3. West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ, UK

    Willem Schenk

Authors
  1. Atesch Ateschrang
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  2. Sufian S. Ahmad
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  3. Ulrich Stöckle
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  4. Steffen Schroeter
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  5. Willem Schenk
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  6. Marc Daniel Ahrend
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Corresponding author

Correspondence to Sufian S. Ahmad.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding was received for the conduction of this study.

Ethical approval

The study was approved by the institutional ethical review board of the Eberhard Karls University of Tübingen in accordance to the Declaration of Helsinki and was given the ID number 431/2013BO1.

Informed consent

Informed consent was received by each study participant.

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Ateschrang, A., Ahmad, S.S., Stöckle, U. et al. Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation. Knee Surg Sports Traumatol Arthrosc 26, 589–595 (2018). https://doi.org/10.1007/s00167-017-4656-x

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  • DOI: https://doi.org/10.1007/s00167-017-4656-x

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