Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study

Abstract

Background: Few studies have reported the return-to-sports (RTS) rate in patients after augmentation of autologous anterior cruciate ligament reconstruction (ACLR) with the Ligament Augmentation and Reconstruction System (LARS). Purpose/Hypothesis: The purpose of this study was to compare postoperative outcomes in patients who underwent ACLR with single-bundle 4-strand hamstring autograft either without augmentation (HA-ACLR group) or with LARS augmentation (AUG-ACLR group). It was hypothesized that clinical outcomes and RTS rates would be better in the AUG-ACLR group at the 1-year follow-up, with similar outcomes in both cohorts by 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR between April 2014 and December 2017 were included in the current comparative study if they were skeletally mature and had 1- and 2-year follow-up outcomes; patients with concomitant meniscal surgery were also included. Included were 66 patients with AUG-ACLR (mean age, 26.8 years; 67% male) and 130 patients with HA-ACLR (mean age, 27.5 years; 61% male). Subjective outcome measures included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score, Lysholm scale, Tegner activity scale, and the Noyes sports activity rating scale. Objective measures included knee laxity, maximal isokinetic knee flexion and extension strength, and the results of 4 functional hop tests. Results: There were no significant differences between the study groups in age, sex distribution, body mass index, time to surgery, or number of concurrent meniscal surgeries. At the 1-year follow-up, the AUG-ACLR group had a significantly higher Tegner score ( P = .001) and rates of RTS ( P = .029) and return to preinjury level of sport ( P = .003) compared with the HA-ACLR group. At the 2-year follow-up, there were no differences in these measures between groups. There were no between-group differences in other subjective outcomes, knee laxity, or strength and hop test results at either postoperative time point. There were also no differences in rerupture rates or other complications between the groups. Conclusion: Patients with AUG-ACLR had higher 1-year postoperative Tegner scores and rates of RTS and preoperative sport level compared with the HA-ACLR group. The 2-year rerupture rate for the AUG-ACLR group was low, and no intra-articular inflammatory complications were noted.

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

“…We should consider that graft retear is a multifactorial phenomenon and the biomechanical properties of the graft are not the blame in all cases of retear [35]. Aujla et al reported a 3.0% overall ipsilateral/contralateral graft retear rate for the augmented ACLR group and a 3.8% retear rate for the standard ACLR group during a 2-years follow up, and similar to our results, they failed to observe a statistically signi cant betweengroup difference [31]. Ebert et al reported a 2.0% ACL retear rate at 7 months postoperatively and 3.0% contralateral ACL tear rate at the 12 months follow up [32].…”

“…None of our patients in both groups received oral postoperative prophylactic antibiotics. in both augmented and standard ACLR groups in one case in each group with early super cial wound infection both treated with antibiotics [31]. Additionally, in a canine arthroscopic ACLR model study for synthetic augmentation of ACL graft, pathologic examination of the 10 augmented quadriceps tendons did not show any evidence of infection [39].…”

Double-bundle anterior cruciate ligament reconstruction using autologous hamstrings with LARS augmentation demonstrates comparable outcomes to hamstrings alone, without evidence of synovitis or early osteoarthritis

“…There is a diminished level of graft strength and stifness observed during the early tissue revascularization process [11], with an associated requirement to control patient activity and associated graft stress with early accelerated rehabilitation potentially risking excessive graft laxity which can be associated with subsequent instability and/or re-injury [27]. Therefore, ACLR surgical techniques augmenting (or reinforcing) an auto or allograft with a synthetic device have been reported [2,4,8,10,13,32], though high rates of synovitis, early osteoarthritic change and failure rates limited the early use and subsequent adoption of synthetics for ACLR [16,18,19,21,22,29,30].…”

There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta‐analysis

“…After reviewing the full text, six articles were excluded through assessment for eligibility. Eventually, 14 articles [3, 5, 7, 11–13, 15, 29, 31, 33, 34, 36, 40, 41] were included in qualitative and quantitative synthesis (Fig. 1).…”