The effect of short-graft preparation with tape suspension and screw fixation on loss of knee extension following anterior cruciate ligament reconstruction: A retrospective cross-sectional analysis of public hospital cases from 2015 - 2017

Abstract

Background: The Tape Locking Screw (TLS®) system for anterior cruciate ligament reconstruction (ACLR) is an emerging short graft with tape suspension (SGTS) technique which uses a single hamstring tendon with tape suspension and dedicated interference screw fixation. Few studies have examined the SGTS technique versus other techniques. The objective of this study was to compare LOE in patients undergoing ACLR with the SGTS technique with other ACLR techniques. We hypothesised that the SGTS technique would be superior to others in terms of minimising LOE. Materials and methods: We retrospectively reviewed 138 patients who received primary ACLR between January 2015 and December 2017 and had elected to participate in a rehabilitation program with the hospital physiotherapy department had postoperative knee extension assessed. Patients were followed up by a department physiotherapist until baseline function was achieved. Patients were grouped as having either SGTS ACLR or non-SGTS ACLR during chart review and compared for LOE at initial assessment and when the maximum extension had been achieved. Results: There were 44 patients in the SGTS group and 94 patients in the non-SGTS group. The SGTS group had a significantly larger median graft diameter (8.5mm vs. 8.0mm, P <0.001) and less incidence of notchplasty (17.8% vs. 44.7%, P <0.001). LOE incidence was significantly associated with the use of notchplasty and graft type at initial assessment. At the time of maximum extension, LOE incidence was significantly associated with LOE at initial assessment, graft size, graft type and lateral meniscus injury. Time to maximum extension was significantly associated with the presence of LOE at initial assessment. Conclusion: In this retrospective analysis, the SGTS technique was not inferior to other ACLR techniques with respect to postoperative loss of extension. Longer time to achieve full extension in the SGTS group was not considered clinically significant. Further studies are needed to assess longer term success and functional outcomes.