Outcomes After Hamstring ACL Reconstruction With Suture Tape Reinforcement in Adolescent Athletes

Abstract

Background: Previous studies have suggested that suture tape-reinforced anterior cruciate ligament (ACL) grafts may have higher ultimate failure loads without stress-shielding. In patients at high risk for graft failure, such as adolescents, the addition of suture tape could have beneficial outcomes. Hypothesis: Suture tape reinforcement (STR) of ACL grafts in adolescent patients would lead to fewer graft ruptures during early recovery, without hindering subjective outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed on adolescent patients with a minimum 2-year follow-up after hamstring tendon autograft ACL reconstruction; enrolled were patients from both before (n = 40) and after (n = 40) a shift in surgical technique that added STR. Both the no-STR and the STR cohorts were contacted yearly to obtain patient-reported outcome data for visual analog scale (VAS; range, 0-10) for pain score, Single Assessment Numeric Evaluation, Lysholm score, Tegner activity score, patient satisfaction score (range, 0-100), and return to previous level of sport (yes/no). The cohorts were then matched based on follow-up duration, excluding those with follow-up of <2 years and >3 years to maintain consistency in duration of follow-up. Graft failure was defined as either graft rupture or recurrent instability symptoms, and failures occurring from index procedure to the 3-year mark were recorded for calculations of failure rate. Results: There were no differences between cohorts in mean age [STR, 15.7 years (range, 9.5-18.7 years); no STR, 14.9 years (range, 9.3-18.8 years)], follow-up duration, laterality, or graft size. While not statistically significant, 2 (5%) patients in the STR cohort experienced graft rupture compared with 7 (17.5%) patients in the no-STR cohort. The Tegner score was significantly higher in the STR cohort ( P = .017); no between-group differences were seen on the other outcome scores. A subanalysis of the STR cohort comparing small-diameter grafts (<8 mm) with grafts ≥8 mm also demonstrated no difference in outcome measures, with 1 graft failure in each cohort. Conclusion: Study outcomes indicated that patients treated with ACL reconstruction and STR experienced a significant improvement in Tegner scores while at the same time maintaining the other subjective outcomes.

Suture tape augmentation, a novel application of synthetic materials in anterior cruciate ligament reconstruction: A systematic review

“…Critical application of the inclusion and exclusion criteria finally yielded nine studies ( Figure 2 ). One was a prospective cohort study (level 2) ( Shantanu et al, 2019 ), six were retrospective cohort studies (level 3) ( Bodendorfer et al, 2019 ; Parkes et al, 2021 ; Allom et al, 2022 ; Kitchen et al, 2022 ; Szakiel et al, 2022 ; von Essen et al, 2022 ), and two were case series (level 4) ( Lavender et al, 2021 ; Duong et al, 2022 ). All seven comparative studies were designed to compare patients who underwent ACLR with and without ST-augmented grafts ( Table 2 ).…”

“…Six studies compared subjective scores between ACLR with or without STA at the final follow-up. The Tegner score used in two studies (Parkes et al, 2021;Kitchen et al, 2022) both yielded superior results in the augmentation group. Results of other scores were inconsistent across studies.…”

Postless Tape Augmentation for Anterior Cruciate Ligament (ACL) Reconstruction

“…In a cohort study of 40 patients in each treatment group, Kitchen et al. 14 demonstrated significantly higher Tegner scores in patients with tape augmentation when compared to those without.…”

“…Further, this technique has demonstrated potential in improving both biomechanical 13 and clinical outcomes following ACL reconstruction. 14 Tape augmentation increases the strength of the graft complex, demonstrating greater load to failure and reduced elongation. 15 However, suture or tape augmentation techniques describe incorporating the suture or tape into a separate post from the ACL graft, such as with tibial anchors 16 or tibial suspensory devices.…”

Reduced Incidence of Revision Anterior Cruciate Ligament Reconstruction With Internal Brace Augmentation

“…2,3,17,23,50 In a scoping review including 6 biomechanical, 3 animal, 10 technical, and 3 clinical studies, Mackenzie et al 23 found that ACLR when augmented with suture tape as an internal brace significantly increased the strength of the graft complex and reduced graft elongation while maintaining equivalent complication rates as well as patient-reported outcomes (PROs) when compared with standard ACLR. Despite the promising results of previous studies that found IB to not only be safe 7,20,23,34,47 but also biomechanically superior to standard ACLR, 2,3,17,23,50,53 an unanswered question is whether ACLR with IB would translate clinically and lead to less graft retears or impact clinical outcomes and PROs.…”