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Seventy percent long-term survival of the repaired ACL after dynamic intraligamentary stabilization

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Primary repair of the anterior cruciate ligament (ACL) is regaining popularity. Long-term results are lacking. The purpose of the current study was to determine the survival of the primarily repaired ACL after dynamic intraligamentary stabilization.

Methods

Between 2011 and 2013, 57 patients with acute proximal ACL ruptures underwent DIS repair within 3 weeks from injury and were available for final follow-up at least 5 years postoperatively. Failure as an end point was defined as conversion to ACL reconstruction, failure to restore stability with persisting laxity side-to-side laxity of > 5 mm or a late-traumatic re-rupture or loss of stability. Kaplan–Meier survival analysis was performed.

Results

Kaplan–Meier survival analysis demonstrated an overall survival of 70.0% (standard error SE 6.6%) at 74 months follow-up. Patients performing competitive sports prior to injury demonstrated an inferior long-term ACL survival of 56.4% (SE 11.6%). Patients performing recreational sport activities demonstrated a survival rate of 79.2% (SE 7.7%). The one factor demonstrating a direct influence on failure after adjustment was a high-pre-injury level of physical (odds ratio 4.0 confidence interval 1.0–15.8, p = 0.04).

Conclusion

The minimum 5 years survival rate after primary ACL repair using this technique was 70%. This value dropped to 56% in highly active patients performing competitive sports. Patients not suffering failure of repair demonstrated adequate restoration of knee laxity and high satisfaction. This study not only underlines the potential of ACL repair, but also highlights the danger of the procedure if strict patient selection is not appreciated.

Level of evidence

Level IV.

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References

  1. Ahmad SS, Difelice GS, van der List JP, Ateschrang A, Hirschmann MT (2019) Primary repair of the anterior cruciate ligament: real innovation or reinvention of the wheel? Knee Surg Sports Traumatol Arthrosc 27:1–2

    Article  Google Scholar 

  2. Ahmad SS, Meyer JC, Krismer AM, Ahmad SS, Evangelopoulos DS, Hoppe S et al (2017) Outcome measures in clinical ACL studies: an analysis of highly cited level I trials. Knee Surg Sports Traumatol Arthrosc 25:1517–1527

    Article  Google Scholar 

  3. Ahmad SS, Schreiner AJ, Hirschmann MT, Schroter S, Dobele S, Ahrend MD et al (2019) Dynamic intraligamentary stabilization for ACL repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:13–20

    Article  Google Scholar 

  4. Crawford SN, Waterman MBR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29:1566–1571

    Article  Google Scholar 

  5. DiFelice GS, van der List JP (2018) Clinical outcomes of arthroscopic primary repair of proximal anterior cruciate ligament tears are maintained at mid-term follow-up. Arthroscopy 34:1085–1093

    Article  Google Scholar 

  6. Feagin JA, Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4:95–100

    Article  Google Scholar 

  7. Hefti E, Müller W, Jakob R, Stäubli H-U (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    Article  CAS  Google Scholar 

  8. Henle P, Röder C, Perler G, Heitkemper S, Eggli S (2015) Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord 16:27

    Article  Google Scholar 

  9. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    Article  CAS  Google Scholar 

  10. Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H et al (2014) A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study. Knee 21:477–480

    Article  Google Scholar 

  11. Kohl S, Evangelopoulos DS, Schar MO, Bieri K, Muller T, Ahmad SS (2016) Dynamic intraligamentary stabilisation: initial experience with treatment of acute ACL ruptures. Bone Jt J 98-b:793–798

    Article  CAS  Google Scholar 

  12. Krismer AM, Gousopoulos L, Kohl S, Ateschrang A, Kohlhof H, Ahmad SS (2017) Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation. Knee Surg Sports Traumatol Arthrosc 25:3923–3928

    Article  Google Scholar 

  13. Leiter JRS, Gourlay R, McRae S, de Korompay N, MacDonald PB (2014) Long-term follow-up of ACL reconstruction with hamstring autograft. Knee Surg Sports Traumatol Arthrosc 22:1061–1069

    Article  Google Scholar 

  14. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

    Article  CAS  Google Scholar 

  15. Meister M, Koch J, Amsler F, Arnold MP, Hirschmann MT (2018) 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

    Article  Google Scholar 

  16. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I (1991) The long-term followup of primary anterior cruciate ligament repair: defining a rationale for augmentation. Am J Sports Med 19:243–255

    Article  CAS  Google Scholar 

  17. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  18. van der List JP, DiFelice GS (2017) Primary repair of the anterior cruciate ligament: a paradigm shift. Surgeon 15:161–168

    Article  Google Scholar 

  19. Weaver JK, Derkash RS, Freeman JR, Kirk RE, Oden RR, Matyas J (1985) Primary knee ligament repair—revisited. Clin Orthop Relat Res 199:185–191

    Google Scholar 

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Funding

No funding was received for the conduction of this study.

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Authors and Affiliations

  1. BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany

    Sufian S. Ahmad

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

    Katharina Schürholz, Emanuel F. Liechti & Frank M. Klenke

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

    Michael T. Hirschmann

  4. Trauma Center Hirslanden Klinik, Zurich, Switzerland

    Sandro Kohl

Authors
  1. Sufian S. Ahmad
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  2. Katharina Schürholz
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  3. Emanuel F. Liechti
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  4. Michael T. Hirschmann
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  5. Sandro Kohl
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  6. Frank M. Klenke
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Corresponding author

Correspondence to Sufian S. Ahmad.

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The authors declare no conflict of interest.

Ethical approval

The study was performed according to its approval by the ethical commission of the canton of Bern, Switzerland (KEK-BE 253/2014).

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Ahmad, S.S., Schürholz, K., Liechti, E.F. et al. Seventy percent long-term survival of the repaired ACL after dynamic intraligamentary stabilization. Knee Surg Sports Traumatol Arthrosc 28, 594–598 (2020). https://doi.org/10.1007/s00167-019-05749-z

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  • DOI: https://doi.org/10.1007/s00167-019-05749-z

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