A comparison of Patient-Reported Outcomes and Post-Operative complications between Suture-Augmented and Standard Hamstring Autograft Single-Bundle ACL Reconstruction: a retrospective cohort study

Abstract

Background Augmentation of the biologic graft with nonabsorbable suture material during anterior cruciate ligament reconstruction (ACLR) is a relatively new technique to enhance its biomechanical properties and add additional support during the critical process of healing. We aim to compare the short-term functional patient-reported outcome measures (PROMs) and complication rates of patients treated with either standard single-bundle four-strand hamstring ACLR or added suture augmentation (SA). Methods: Patients undergoing arthroscopic ACLR between February 2015 and September 2019 in the standard ACLR group (79 patients) and the SA-ACLR group (90 patients) operated by adding a no.5 FiberWire® (Arthrex, Naples, FL, USA) braided suture to the hamstring autograft were retrospectively comared together in this study. Patients were followed up for a 24-month period and PROMs were assessed and compared by the International Knee Documentation Committee (IKDC) Subjective Knee Form and Tegner-Lysholm knee score. Patients’ demographic and clinical characteristics and postoperative complications including graft retear requiring revision surgery, deep vein thrombois, and surgical site infection were recorded and analyzed. Results Mean age was 31.6 ± 8.3 in standard ACLR and 30.5 ± 7.6 in SA-ACLR. There was no statistically significant difference between the two groups in terms of age, sex, body mass index, and medical comorbidities. The values of the IKDC scores increased to 75.8 ± 18.9 in the standard ACLR group, and 85.6 ± 12.6 in the SA-ACLR group, 24 months after the operation (P<0.05). The 24-month postoperative Tegner-Lysholm scores escalated to 79.3 ± 21.0 in the standard ACLR group and 91.0 ± 13.7 in the SA-ACLR group (P<0.05). Four (5.1%) patients in the standard ACLR group and 4 (4.4%) in the SA-ACLR group experienced graft retear requiring revision surgery (P>0.05). Surgical site infection and deep vein thrombosis showed no significant difference between the two groups two years after ACLR. Conclusion SA-ACLR is associated with improved short-term functional PROMs compared to the standard hamstring ACLR. Although SA did not reduce retear rate, and infection and DVT were not differ between study groups, superior improvement of PROMs in SA approach, leverages this method for ACLR.