Bridge-enhanced ACL repair may yield better outcomes, strength vs ACL reconstruction
SAN DIEGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed bridge-enhanced ACL repair may lead to higher outcome scores and hamstring strength compared with ACL reconstruction.
Dennis E. Kramer, MD, and colleagues randomly assigned 100 patients aged 13 to 35 years with complete ACL injuries to undergo either bridge-enhanced ACL repair (BEAR) or autograft ACL reconstruction.
“What this study looked at was how did these patients do from a patient reported and functional standpoint at different time periods during the first 2 years after surgery,” Kramer, assistant professor of orthopedic surgery at Boston Children’s Hospital and Harvard Medical School, told Healio Orthopedics. “In other words, how was their IKDC scores and KOOS scores affected at 3 months, 6 months, 1 year and 2 years after surgery, and also how was their muscle strength and hop test affected at these different time points.”
Kramer noted patients in the BEAR group had significantly better IKDC scores at the 6-month follow-up, as well as at all time points in the study, compared with the ACL reconstruction group.
“In essence, the BEAR patients liked their knees significantly better at the 6-month time point and then overall, at all time points, if you summed all those up, the BEAR patients liked their knees a little better from an IKDC standpoint compared to the reconstruction group,” Kramer said.
Patients in the BEAR group also had higher KOOS scores at the 1-year time point vs. the ACL reconstruction group, according to Kramer. However, he noted the difference in IKDC and KOOS scores decreased with time.
“So both scores, while they were better in the BEAR group at one particular time point, the improvement diminished over time; but, summarized over time, was higher in the BEAR group than the ACL reconstruction group,” Kramer said.
When looking at strength, Kramer noted patients in the BEAR group had significantly higher hamstring strength at all time points. He added 88% of patients in the BEAR group and 76% of patients in the ACL reconstruction group were cleared for return to sports 1 year after surgery.
“This finding was not statistically significant and also somewhat subjective. We didn’t have objective criteria for return to sport,” Kramer said. “It was up to each individual physician but still interesting that the physicians of the BEAR patients had slightly higher clearance for return to sport than the ACL reconstruction group at 1-year postop.”
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Barnett S, et al. Paper 189. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. Aug. 31-Sept. 3, 2021; San Diego.