Earlier Resolution of Symptoms and Return of Function After Bridge-Enhanced Anterior Cruciate Ligament Repair As Compared With Anterior Cruciate Ligament Reconstruction

Abstract

Background: Bridge-enhanced anterior cruciate ligament repair (BEAR) has noninferior patient-reported outcomes when compared with autograft anterior cruciate ligament reconstruction (ACLR) at 2 years. However, the comparison of BEAR and autograft ACLR at earlier time points—including important outcomes such as resolution of knee pain and symptoms, recovery of strength, and return to sport—has not yet been reported. Hypothesis: It was hypothesized that the BEAR group would have higher outcomes on the International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score, as well as improved muscle strength, in the early postoperative period. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 100 patients aged 13 to 35 years with complete midsubstance anterior cruciate ligament injuries were randomized to receive a suture repair augmented with an extracellular matrix implant (n = 65) or an autograft ACLR (n = 35). Outcomes were assessed at time points up to 2 years postoperatively. Mixed-model repeated-measures analyses were used to compare BEAR and ACLR outcomes. Patients were unblinded after their 2-year visit. Results: Repeated-measures testing revealed a significant effect of group on the International Knee Documentation Committee Subjective Score ( P = .015), most pronounced at 6 months after surgery (BEAR = 86 points vs ACLR = 78 points; P = .001). There was a significant effect of group on the Knee injury and Osteoarthritis Outcome Score-Symptoms subscale scores ( P = .010), largely attributed to the higher BEAR scores at the 1-year postoperative time point (88 vs 82; P = .009). The effect of group on hamstring strength was significant in the repeated-measures analysis ( P < .001), as well as at all postoperative time points ( P < .001 for all comparisons). At 1 year after surgery, approximately 88% of the patients in the BEAR group and 76% of the ACLR group had been cleared for return to sport ( P = .261). Conclusion: Patients undergoing the BEAR procedure had earlier resolution of symptoms and increased satisfaction about their knee function, as well as improved resolution of hamstring muscle strength throughout the 2-year follow-up period. Registration: NCT02664545 (ClinicalTrials.gov identifier)

Psychological Readiness to Return to Sport at 6 Months Is Higher After Bridge-Enhanced ACL Restoration Than Autograft ACL Reconstruction: Results of a Prospective Randomized Clinical Trial

“…We also used t tests to compare BEAR and ACLR groups on selected 6-month outcomes; some results have been reported in a previous study. 4 Mixed-model repeated-measures analyses based on restricted maximum likelihood were used to compare temporal changes between BEAR and ACLR groups on ACL-RSI scores across postsurgical assessments. The model included 3 fixed factors (group [BEAR, ACLR], time [6, 12 and 24 months], and sex [male, female]), along with their interactions.…”

“…Outcomes at 6 Months and Their Association With 6-Month ACL-RSI. The 6-month IKDC, dynamometer, instrumented AP laxity, and hop testing outcomes have been reported previously 4 and are shown in Table 4. Patients randomized to the BEAR procedure significantly higher IKDC subjective scores at 6 months compared with patients with ACLR (P ¼ .014) and superior functional outcomes for hamstring (P < .001) and hamstring to quadriceps ratio (P < .001).…”

“…16,28 An important finding in a follow-up study was that patients with BEAR demonstrated superior hamstring strength across all postoperative assessments (3,6,12, and 24 months) and greater hip adductor strength overall compared with patients with ACLR, most of whom underwent hamstring graft harvest. 4 Given the faster physical recovery with regard to strength in patients with BEAR, we suspected these patients may also recover faster from a psychological perspective.…”

Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration

“…All measures were performed on each knee in duplicate, and the duplicates were averaged. 3 During the single-leg hop test, patients wore a brace on the surgically treated knee.…”

“…using a commercially available image viewer (Osirix Viewer Version 8.5; Pixmeo SARL). 25,26 Patient Follow-up and Nonimaging Outcome Measures Six patient-reported, clinical, and functional outcomes were assessed between 6 and 9 months after surgery: (1) the IKDC subjective score, 23,36 (2) the side-to-side difference in KT knee laxity, 12 (3) the quadriceps strength ratio (% surgical/contralateral), 3 (4) the hamstring strength ratio (% surgical/contralateral), 3 (5) quadriceps-hamstring strength ratio of the surgical leg, 3 and (6) single-leg hop ratio (% surgical/contralateral). 43 The IKDC subjective score was calculated based on patients' responses to the IKDC questionnaire.…”