Five year results of the first ten ACL patients treated with dynamic intraligamentary stabilisation

Abstract

BackgroundIn recent years, the scientific discussion has focused on new strategies to enable a torn anterior cruciate ligament (ACL) to heal into mechanically stable scar tissue. Dynamic intraligamentary stabilization (DIS) with LigamysTM was first performed in a pilot study of 10 patients. The purpose of the current study was to evaluate the five year results of this group.MethodsInclusion criteria were an ACL rupture not older than 14 days, patient age <45 years, no previous surgery on the injured knee, and regular participation in sports requiring pivoting of the knee joint. Ten consecutive patients (eight males, two females) underwent surgery between August 2009 and February 2010. They were treated by DIS employing an internal stabilizer to keep the unstable knee in a posterior translation, combined with microfracturing and platelet-rich fibrin induction at the rupture site to promote self-healing. Postoperative clinical outcome [Tegner, Lysholm, International Knee Documentation Committee (IKDC), visual analogue scale patient satisfaction score] and assessment of knee laxity was performed at 3, 6, 12, 24 and 60 months.ResultsMedian patient age at time of surgery was 23.3 years (range 19–41 years). The median time to surgery was 10 days (range 5–13 days). The rupture was located in the middle third of the ligament in seven patients and in the proximal third in three patients. Eight patients showed additional meniscal lesions, which were surgically treated in six patients. Eight of the ten patients reached the five-years follow-up. Median Lysholm score was 100 (range 90–100); the IKDC score was 98.9 (range 79.3–100); Tegner score was 5.5 (range 5–7); median Lachman difference to the other side was 2 mm (range 0–4 mm). Median patient satisfaction was 10 points (range 8–10 pts.). Four of the ten patients underwent metal removal (tibial implant component) after ACL healing and a consequently stable knee joint. Two patients suffered from a re-rupture at 5 months and 4.2 years after surgery and were treated with a bone-tendon-bone ACL graft.ConclusionsDynamic intraligamentary stabilization in ten active patients with a fresh ACL rupture showed a 5-years survival rate of 80 %. At the last follow-up all patients with a functionally healed ACL showed excellent outcomes and satisfaction with regards to the treatment result.

The non-reconstructive treatment of complete ACL tear with biological enhancement in clinical and preclinical studies: A systematic review

“…Among them, seven articles were clinical studies and 11 articles were animal studies. Of the 7 clinical studies, there were 5 level Ⅳ case-series studies, 2 , 15 , 16 , 17 , 18 1 level Ⅲ retrospective case-control studies 19 and 1 level Ⅲ cohort study 20 ( Fig. 1 ).…”

“… 18 , a Case series 69 42:27 32.4 ≥24 Microfracturing Sutures and DIS 2.9% Instrumented SSD: 2.3 mm Lysholm: 97, Tegner: 5.1, IKDC: 94.8 10 Eggli et al. 15 Case series 10 8:2 23.3 60.3 Microfracturing Sutures and DIS 20% Instrumented SSD: 2 mm Lysholm: 100, Tegner: 5.5, IKDC: 98.9 10 Murray et al. 20 Cohort Study: 10 Control: 10 6:14 24 3 BEAR scaffold Suture 0% Study group vs control group Lachman test: 8 grade A, 2 grade B vs 10 grade A IKDC: 54.3 vs 60.7 20 M, male; F, female; mo, months; yr, year; F/U, follow-up; d, day; mo, month NP, not provided; HRT, healing response technique; DIS, dynamic intraligamentary stabilization.…”

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

“…The minimum follow-up was 12 months, with a mean follow-up of 21 months (range, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. All the patients underwent surgery within 3 weeks after injury.…”

Reinterventions after dynamic intraligamentary stabilization in primary anterior cruciate ligament repair

“…Advantages of this technique include preservation of the native ligament with its proprioceptive nerve fibers and the lack of donor site morbidity because no graft harvesting is necessary. Recent studies have shown that this ACL preserving technique achieves good clinical mid-term results with high functional scores and patient satisfaction [1][2][3][4][5]. However, the revision rate in the current literature ranges from 2.8% to 20.0% depending on the follow-up period, cohort, and, most importantly, the definition of revision itself, which is not uniformly defined throughout the different studies [1][2][3][4][5].…”

“…The goals of this study were, therefore, the following: (1) to determine the frequency of revision and non-revision reinterventions after DIS treatment; and (2) to analyze the different types of revision and non-revision reinterventions and the associated reasons. We hypothesized that: (1) the revision rate was in the range of published results after ACL reconstructions; and (2) non-revision reinterventions were performed more frequently.…”