RESUMEN
PURPOSE: Primary repair of the anterior cruciate ligament (ACL) is regaining popularity. Long-term results are lacking. The purpose of the current study was to determine the survival of the primarily repaired ACL after dynamic intraligamentary stabilization. METHODS: Between 2011 and 2013, 57 patients with acute proximal ACL ruptures underwent DIS repair within 3 weeks from injury and were available for final follow-up at least 5 years postoperatively. Failure as an end point was defined as conversion to ACL reconstruction, failure to restore stability with persisting laxity side-to-side laxity of > 5 mm or a late-traumatic re-rupture or loss of stability. Kaplan-Meier survival analysis was performed. RESULTS: Kaplan-Meier survival analysis demonstrated an overall survival of 70.0% (standard error SE 6.6%) at 74 months follow-up. Patients performing competitive sports prior to injury demonstrated an inferior long-term ACL survival of 56.4% (SE 11.6%). Patients performing recreational sport activities demonstrated a survival rate of 79.2% (SE 7.7%). The one factor demonstrating a direct influence on failure after adjustment was a high-pre-injury level of physical (odds ratio 4.0 confidence interval 1.0-15.8, p = 0.04). CONCLUSION: The minimum 5 years survival rate after primary ACL repair using this technique was 70%. This value dropped to 56% in highly active patients performing competitive sports. Patients not suffering failure of repair demonstrated adequate restoration of knee laxity and high satisfaction. This study not only underlines the potential of ACL repair, but also highlights the danger of the procedure if strict patient selection is not appreciated. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Inestabilidad de la Articulación/cirugía , Adulto , Anciano , Ligamento Cruzado Anterior/cirugía , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Rotura , Adulto JovenRESUMEN
PURPOSE: New strategies for dynamic intraligamentary stabilization (DIS) in the primary repair of anterior cruciate ligament (ACL) ruptures are currently under debate. It has been proposed that these might serve as alternative techniques to conventional ACL reconstruction procedures using tendon autografts. The aims of the present investigation were to evaluate the functional results and critically assess the complication rate following primary ACL repair with DIS and to review existing reports of favourable clinical results with the method in relation to knee joint stability and patient satisfaction. METHODS: Fifty-nine patients received dynamic intraligamentary stabilization a mean of 14 days after ACL rupture. Fifty-seven patients (96.6%, male:female = 37:20; mean age 27.6 years) were available for follow-up examinations including the Tegner activity level, anteroposterior stability in comparison with the uninjured knee, subjective satisfaction, and range of knee motion. Complications after 3 and 12 months were also analyzed. Associated lesions requiring surgical measures were found in 30 patients. RESULTS: A statistically significant decrease in Tegner activity levels was detected between the preoperative status (median 7) and the 12-month follow-up (median 5). The overall complication rate was 57.9%, including rerupture or non-healing (n = 10, 17.5%), repeat arthroscopy (n = 13, 22.8%) as a result of meniscus tears (n = 2, 15.4%), cyclops syndrome (n = 4, 30.8%) or restricted range of motion (n = 7, 53.8%), arthrofibrosis (n = 3, 5.3%), and implant interference (n = 7, 12.3%). Anteroposterior KT-1000 stability of 3 mm or below was achieved in 29 (50.9%) patients. CONCLUSIONS: The DIS procedure does not appear to be appropriate for providing predictable results in a young and active cohort of patients following ACL rupture, as it has an unacceptably high complication rate and leads to residual anteroposterior knee joint laxity of 3 mm or more in 28 (49.1%) of cases. LEVEL OF EVIDENCE: IV (prospective case series).
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirugía , Inestabilidad de la Articulación/cirugía , Complicaciones Posoperatorias , Adolescente , Adulto , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Artroscopía , Traumatismos en Atletas/cirugía , Femenino , Humanos , Articulación de la Rodilla/cirugía , Escala de Puntuación de Rodilla de Lysholm , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Rango del Movimiento Articular/fisiología , Rotura/cirugía , Adulto JovenRESUMEN
PURPOSE: Most of the clinical outcome studies dealing with ACL repair are from the developer's perspective. It is a fact that these developer-initiated studies tend to interpret the results rather in favour than against their developed technique or product. Hence, it was the purpose of the present independent investigator-initiated study to investigate the clinical and radiological outcomes as well as failure rate of patients who underwent an ACL suture using dynamic intraligamentary stabilisation device in a specialised independent knee clinic. METHODS: A retrospective study was performed on prospectively collected data of 26 patients (28 ± 9 years, range 18-50 years; male/female = 17:9) who underwent biologically augmented ACL suture using dynamic intraligamentary stabilisation. Mean time from ACL injury was 15 ± 5 days (range 4-25 days). In addition, in seven (27%) patients a medial meniscus refixation and in four (15%) patients a lateral meniscus refixation was done for associated meniscal lesions. All patients were clinically and radiologically followed up at 6 weeks, 3 and 12 months after ACL surgery using the Tegner and Lysholm score as well as IKDC score. Adverse events such as ACL failure, arthrofibrosis, pain > 3 on a visual analogue scale as well as the need and type of revision surgery were noted. RESULTS: Four patients (15%) suffered from an ACL retear due to another adequate trauma during follow-up time. In six patients (23%), an arthrofibrosis (extension deficit of > 10° or flexion deficit > 20°) was noted. In five of those six patients, an arthroscopic arthrolysis was performed. Three patients also complained about pain VAS > 3. In nine (35%) patients, superfluous ACL scar tissue and the DIS device including the polyethylene suture and the DIS screw were removed, and in another two (8%) patients, the DIS screw only was removed. In two patients, a partial meniscectomy was performed due to a non-healed meniscal suture. The median Tegner score was 8 (range 6-10) before injury and 7 (range 3-10) at last follow-up (p < 0.001). The mean Lysholm score before surgery was 28 ± 14 and 94 ± 11 at last follow-up (p < 0.001). At last follow-up, 14 patients (66%) showed a normal total IKDC score (A) and 4 patients (19%) were nearly normal (B) and 2 patients (10%) were slightly abnormal (C) and one patient (5%) was entirely abnormal (p < 0.001). CONCLUSION: ACL suturing using the dynamic intraligamentary stabilisation device showed satisfying clinical results at 12-month follow-up. However, a retear rate of 15% and a reoperation rate of 35% due to retear or arthrofibrosis appear rather high. These results highlight the importance of adequate patient selection and the delicacy of the surgical procedure. LEVEL OF EVIDENCE: Retrospective case series, Level IV.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Reoperación/estadística & datos numéricos , Técnicas de Sutura , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Escala Visual Analógica , Cicatrización de Heridas , Adulto JovenRESUMEN
AIMS: The purpose of this study was to report the experience of dynamic intraligamentary stabilisation (DIS) using the Ligamys device for the treatment of acute ruptures of the anterior cruciate ligament (ACL). PATIENTS AND METHODS: Between March 2011 and April 2012, 50 patients (34 men and 16 women) with an acute rupture of the ACL underwent primary repair using this device. The mean age of the patients was 30 years (18 to 50). Patients were evaluated for laxity, stability, range of movement (ROM), Tegner, Lysholm, International Knee Documentation Committee (IKDC) and visual analogue scale (VAS) scores over a follow-up period of two years. RESULTS: At final follow-up, anteroposterior translation differed from the normal knee by a mean of 0.96 mm (-2 mm to 6 mm). Median (interquartile range) IKDC, Tegner, Lysholm and VAS scores were 98 (95 to 100), 6 (5 to 7), 100 (98 to 100) and 10 (9 to 10), respectively. Pre-injury Tegner activity levels were reached one year post-operatively. A total of nine patients (18%) required a secondary intervention; five developed instability, of whom four underwent secondary hamstring reconstructive surgery, and five required arthroscopic treatment for intra-articular impingement due to scar tissue which caused a fixed flexion deformity. In addition, 30 patients (60%) required removal of the tibial screw. CONCLUSION: While there was a high rate of secondary interventions, 45 patients (90%) retained their repaired ACL two years post-operatively, with good clinical scores and stability of the knee. TAKE HOME MESSAGE: Dynamic intraligamentary stabilisation presents a promising treatment option for acute ACL ruptures, eliminating the need for ACL reconstruction. Cite this article: Bone Joint J 2016;98-B:793-8.