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ACL suturing using dynamic intraligamentary stabilisation showing good clinical outcome but a high reoperation rate: a retrospective independent study

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

Abstract

Purpose

Most of the clinical outcome studies dealing with ACL repair are from the developer’s perspective. It is a fact that these developer-initiated studies tend to interpret the results rather in favour than against their developed technique or product. Hence, it was the purpose of the present independent investigator-initiated study to investigate the clinical and radiological outcomes as well as failure rate of patients who underwent an ACL suture using dynamic intraligamentary stabilisation device in a specialised independent knee clinic.

Methods

A retrospective study was performed on prospectively collected data of 26 patients (28 ± 9 years, range 18–50 years; male/female = 17:9) who underwent biologically augmented ACL suture using dynamic intraligamentary stabilisation. Mean time from ACL injury was 15 ± 5 days (range 4–25 days). In addition, in seven (27%) patients a medial meniscus refixation and in four (15%) patients a lateral meniscus refixation was done for associated meniscal lesions. All patients were clinically and radiologically followed up at 6 weeks, 3 and 12 months after ACL surgery using the Tegner and Lysholm score as well as IKDC score. Adverse events such as ACL failure, arthrofibrosis, pain > 3 on a visual analogue scale as well as the need and type of revision surgery were noted.

Results

Four patients (15%) suffered from an ACL retear due to another adequate trauma during follow-up time. In six patients (23%), an arthrofibrosis (extension deficit of > 10° or flexion deficit > 20°) was noted. In five of those six patients, an arthroscopic arthrolysis was performed. Three patients also complained about pain VAS > 3. In nine (35%) patients, superfluous ACL scar tissue and the DIS device including the polyethylene suture and the DIS screw were removed, and in another two (8%) patients, the DIS screw only was removed. In two patients, a partial meniscectomy was performed due to a non-healed meniscal suture. The median Tegner score was 8 (range 6–10) before injury and 7 (range 3–10) at last follow-up (p < 0.001). The mean Lysholm score before surgery was 28 ± 14 and 94 ± 11 at last follow-up (p < 0.001). At last follow-up, 14 patients (66%) showed a normal total IKDC score (A) and 4 patients (19%) were nearly normal (B) and 2 patients (10%) were slightly abnormal (C) and one patient (5%) was entirely abnormal (p < 0.001).

Conclusion

ACL suturing using the dynamic intraligamentary stabilisation device showed satisfying clinical results at 12-month follow-up. However, a retear rate of 15% and a reoperation rate of 35% due to retear or arthrofibrosis appear rather high. These results highlight the importance of adequate patient selection and the delicacy of the surgical procedure.

Level of evidence

Retrospective case series, Level IV.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Martin Meister, Jonathan Koch & Michael T. Hirschmann

  2. Amsler Consulting, Basel, Switzerland

    Felix Amsler

  3. LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland

    Markus P. Arnold

  4. University of Basel, Basel, Switzerland

    Markus P. Arnold & Michael T. Hirschmann

Authors
  1. Martin Meister
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  2. Jonathan Koch
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  3. Felix Amsler
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  4. Markus P. Arnold
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  5. Michael T. Hirschmann
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Corresponding author

Correspondence to Michael T. Hirschmann.

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Conflict of interest

All authors declare that they have no conflict of interest.

Funding

There was no financial conflict of interest with regards to this study.

Ethical approval

Ethical approval was obtained from the Ethikkommission Nordwest- und Zentralschweiz (2014/167, EKNZ, Basel). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Meister, M., Koch, J., Amsler, F. et al. ACL suturing using dynamic intraligamentary stabilisation showing good clinical outcome but a high reoperation rate: a retrospective independent study. Knee Surg Sports Traumatol Arthrosc 26, 655–659 (2018). https://doi.org/10.1007/s00167-017-4726-0

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  • DOI: https://doi.org/10.1007/s00167-017-4726-0

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