Augmented ACL reconstruction yielded faster functional recovery vs. no augmentation
Click Here to Manage Email Alerts
Key takeaways:
- ACL reconstruction with bone marrow aspirate, demineralized bone matrix and suture tape may improve functional outcomes.
- Augmented ACL reconstruction yielded superior outcomes vs. standard ACL surgery.
Published results showed ACL reconstruction augmented with bone marrow aspirate concentrate, demineralized bone matrix and suture tape yielded superior functional outcomes and faster recovery compared with standard ACL reconstruction.
Chad D. Lavender, MD, assistant professor in the department of orthopedics at Marshall University Health in Huntington, West Virginia, and colleagues performed a prospective, randomized controlled trial that compared outcomes of 29 patients who underwent augmented ACL reconstruction and 30 patients who underwent standard ACL reconstruction.
According to the study, patients who underwent augmented ACL reconstruction received bone marrow aspirate concentrate (BMAC), demineralized bone matrix (DBM) and suture tape.
Outcome measures included patient-reported outcomes, radiographic outcomes, range of motion (ROM), limb symmetry and complications.
Lavender and colleagues found that compared with patients who underwent standard ACL reconstruction, patients who underwent augmented ACL reconstruction had better knee flexion at 6 weeks (125° vs. 109°), limb symmetry at 12 weeks (80.6% vs. 36.7%) and KOOS quality of life scores at 2 years (85.2 vs. 72.1). They noted IKDC scores were similar between the cohorts at 2 years (91.1 for the augmented group vs. 85.3 for the standard group).
After radiographic analysis of 22 patients who had CT scans at 6 months, Lavender and colleagues found a significantly smaller mean increase in bone tunnel diameter among patients who underwent augmented ACL reconstruction vs. patients who underwent standard ACL reconstruction. In addition, Lavender and colleagues found no significant differences between the groups for rates of graft ruptures or reoperations.
Lavender and colleagues hypothesized that faster healing times from ACL reconstruction with BMAC, DBM and suture tape may expedite return to play for athletes who require ACL surgery.
Perspective
Back to Top
Alexander K. Meininger, MD, FAAOS
The authors are applauded for the successful accomplishment of a randomized controlled trial in ACL surgery, particularly during the COVID-19 pandemic. Lavender and colleagues sought to evaluate the effect of biologic and biomechanical ACL augmentation on early recovery, bone tunnel-graft integration and outcomes at 2 years. The two groups included a fertilized ACL cohort treated with BMAC, DBM and suture tape augmentation as compared to a control group of the unfertilized, standard, unaugmented ACL reconstruction. Overall, 72% of the fertilized and 73% of the unfertilized cohort received quadriceps tendon autograft. Unfortunately, that means 27% of the unfertilized cohort received allograft ACL reconstruction.
Allograft integration is known to be slower and more time-consuming for bone tunnel integration. Therefore, the question of early graft healing plus or minus biological augmentation is difficult to evaluate when comparing mixed graft recipients. As stated, subgroup analysis would have added to the publication.
Regarding suture tape augmentation, the study showed no difference in 2-year graft re-rupture rates questioning the added expense. Does the rigid biomechanics of the suture tape augmentation or the biologic augmentation of BMAC and DBM add to early bone tunnel integration? Based on this study, further clinical study is necessary to discern if biological augmentation does in fact accelerate ACL graft bone tunnel integration.
Lastly, limb symmetry and return to sports testing at 12 weeks may be on an accelerated track. It is becoming widely accepted that ACL reconstruction patients require 8 to 9 months before successful return to sports; particularly in those who receive concomitant meniscus repair. This study included 40 of 59 patients with concomitant meniscus repair. It is difficult to attribute early 12-week limb symmetry and strength recoupment to techniques of augmentation when the standard return to sports is often greater than 36 weeks.
This study adds to the literature of clinical success at 2 years with suture tape augmentation. However, the question remains if the cost is worth the benefit when unaugmented patients demonstrated similar 2-year outcomes and revision rates.
References:
Başal Ö, et al. Ulus Travma Acil Cerrahi Derg. 2022;doi:10.14744/tjtes.2022.13614.
Beischer S, et al. J Orthop Sports Phys Ther. 2020;doi:10.2519/jospt.2020.9071.
Gotlin M, et al. Bull Hosp Jt Dis (2013). 2023;Sep;81(3):198-204.
Wellsandt E, et al. J Orthop Sports Phys Ther. 2017;doi:10.2519/jospt.2017.7285.
Collapse
Click Here to Manage Email Alerts