ACL Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Provides Good Clinical Scores, High Levels of Satisfaction and Return to Sport, and a Low Retear Rate at 2 Years

Jay R. Ebert, Peter T. Annear

Research output: Contribution to journalArticle

Abstract

Background: There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65% of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates. Purpose: To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS). Study Design: Case series; Level of evidence, 4. Methods: A total of 65 patients were prospectively treated with arthroscopically assisted single-bundle ACLR using hamstrings augmented with the LARS, of whom 50 were available for 1- and 2-year reviews. Patient-reported outcome measures (PROMs), KT-1000 arthrometer testing, knee range of motion, peak isokinetic knee strength testing, and a battery of 4 hop tests were employed. Limb symmetry indices (LSIs) were calculated. Analysis of variance was used to evaluate differences over time and between limbs. Data on return to the preinjury level of sport, retears, and reoperations were collected. Results: High PROM scores were demonstrated at 1 and 2 years. Before the injury, 47 patients (94%) were actively participating in level 1 or 2 sports, with 38 (76%) and 43 (86%) patients having returned at 1 and 2 years, respectively. Normal (<3 mm; 90%) or nearly normal (3-5 mm; 10%) KT-1000 arthrometer side-to-side differences were observed at 2 years. Apart from knee flexion (P <.0001), extension (P =.001), and the 6-m timed hop (P =.039), there were no between-limb differences at 1 year, and there were no differences on any objective measures at 2 years (all P >.05). Mean LSIs across all measures were ≥90%. At 2 years, 84% to 90% of patients were ≥90% on the hop tests, with 72% and 76% of patients having ≥90% for extension and flexion strength, respectively. Two reoperations were undertaken for meniscal tears (7 and 8.5 months), 1 patient (2%) suffered a retear at 7 months, and 2 patients (3%) suffered a contralateral tear (8 and 12 months). Conclusion: This augmented ACLR technique demonstrated good clinical scores, a high rate of return to sport, and low rates of secondary ruptures and contralateral ACL tears at 2 years. Some caution should be noted in interpreting these results, as 15 of 65 patients (23%) were not included in the 2-year follow-up.

Original languageEnglish
JournalOrthopaedic Journal of Sports Medicine
Volume7
Issue number10
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Anterior Cruciate Ligament Reconstruction
Ligaments
Tears
Sports
Humulus
Extremities
Reoperation
Knee
Return to Sport
Articular Range of Motion
Rupture
Analysis of Variance
Wounds and Injuries

Cite this

@article{87a3c0264e3d4098a8e0abda6ef648c8,
title = "ACL Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Provides Good Clinical Scores, High Levels of Satisfaction and Return to Sport, and a Low Retear Rate at 2 Years",
abstract = "Background: There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65{\%} of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates. Purpose: To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS). Study Design: Case series; Level of evidence, 4. Methods: A total of 65 patients were prospectively treated with arthroscopically assisted single-bundle ACLR using hamstrings augmented with the LARS, of whom 50 were available for 1- and 2-year reviews. Patient-reported outcome measures (PROMs), KT-1000 arthrometer testing, knee range of motion, peak isokinetic knee strength testing, and a battery of 4 hop tests were employed. Limb symmetry indices (LSIs) were calculated. Analysis of variance was used to evaluate differences over time and between limbs. Data on return to the preinjury level of sport, retears, and reoperations were collected. Results: High PROM scores were demonstrated at 1 and 2 years. Before the injury, 47 patients (94{\%}) were actively participating in level 1 or 2 sports, with 38 (76{\%}) and 43 (86{\%}) patients having returned at 1 and 2 years, respectively. Normal (<3 mm; 90{\%}) or nearly normal (3-5 mm; 10{\%}) KT-1000 arthrometer side-to-side differences were observed at 2 years. Apart from knee flexion (P <.0001), extension (P =.001), and the 6-m timed hop (P =.039), there were no between-limb differences at 1 year, and there were no differences on any objective measures at 2 years (all P >.05). Mean LSIs across all measures were ≥90{\%}. At 2 years, 84{\%} to 90{\%} of patients were ≥90{\%} on the hop tests, with 72{\%} and 76{\%} of patients having ≥90{\%} for extension and flexion strength, respectively. Two reoperations were undertaken for meniscal tears (7 and 8.5 months), 1 patient (2{\%}) suffered a retear at 7 months, and 2 patients (3{\%}) suffered a contralateral tear (8 and 12 months). Conclusion: This augmented ACLR technique demonstrated good clinical scores, a high rate of return to sport, and low rates of secondary ruptures and contralateral ACL tears at 2 years. Some caution should be noted in interpreting these results, as 15 of 65 patients (23{\%}) were not included in the 2-year follow-up.",
keywords = "anterior cruciate ligament reconstruction, augmentation, clinical outcomes, knee function, retear, return to sport",
author = "Ebert, {Jay R.} and Annear, {Peter T.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/2325967119879079",
language = "English",
volume = "7",
journal = "Orthopaedic Journal of Sports Medicine",
issn = "2325-9671",
publisher = "SAGE Publications Ltd",
number = "10",

}

TY - JOUR

T1 - ACL Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Provides Good Clinical Scores, High Levels of Satisfaction and Return to Sport, and a Low Retear Rate at 2 Years

AU - Ebert, Jay R.

AU - Annear, Peter T.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65% of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates. Purpose: To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS). Study Design: Case series; Level of evidence, 4. Methods: A total of 65 patients were prospectively treated with arthroscopically assisted single-bundle ACLR using hamstrings augmented with the LARS, of whom 50 were available for 1- and 2-year reviews. Patient-reported outcome measures (PROMs), KT-1000 arthrometer testing, knee range of motion, peak isokinetic knee strength testing, and a battery of 4 hop tests were employed. Limb symmetry indices (LSIs) were calculated. Analysis of variance was used to evaluate differences over time and between limbs. Data on return to the preinjury level of sport, retears, and reoperations were collected. Results: High PROM scores were demonstrated at 1 and 2 years. Before the injury, 47 patients (94%) were actively participating in level 1 or 2 sports, with 38 (76%) and 43 (86%) patients having returned at 1 and 2 years, respectively. Normal (<3 mm; 90%) or nearly normal (3-5 mm; 10%) KT-1000 arthrometer side-to-side differences were observed at 2 years. Apart from knee flexion (P <.0001), extension (P =.001), and the 6-m timed hop (P =.039), there were no between-limb differences at 1 year, and there were no differences on any objective measures at 2 years (all P >.05). Mean LSIs across all measures were ≥90%. At 2 years, 84% to 90% of patients were ≥90% on the hop tests, with 72% and 76% of patients having ≥90% for extension and flexion strength, respectively. Two reoperations were undertaken for meniscal tears (7 and 8.5 months), 1 patient (2%) suffered a retear at 7 months, and 2 patients (3%) suffered a contralateral tear (8 and 12 months). Conclusion: This augmented ACLR technique demonstrated good clinical scores, a high rate of return to sport, and low rates of secondary ruptures and contralateral ACL tears at 2 years. Some caution should be noted in interpreting these results, as 15 of 65 patients (23%) were not included in the 2-year follow-up.

AB - Background: There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65% of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates. Purpose: To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS). Study Design: Case series; Level of evidence, 4. Methods: A total of 65 patients were prospectively treated with arthroscopically assisted single-bundle ACLR using hamstrings augmented with the LARS, of whom 50 were available for 1- and 2-year reviews. Patient-reported outcome measures (PROMs), KT-1000 arthrometer testing, knee range of motion, peak isokinetic knee strength testing, and a battery of 4 hop tests were employed. Limb symmetry indices (LSIs) were calculated. Analysis of variance was used to evaluate differences over time and between limbs. Data on return to the preinjury level of sport, retears, and reoperations were collected. Results: High PROM scores were demonstrated at 1 and 2 years. Before the injury, 47 patients (94%) were actively participating in level 1 or 2 sports, with 38 (76%) and 43 (86%) patients having returned at 1 and 2 years, respectively. Normal (<3 mm; 90%) or nearly normal (3-5 mm; 10%) KT-1000 arthrometer side-to-side differences were observed at 2 years. Apart from knee flexion (P <.0001), extension (P =.001), and the 6-m timed hop (P =.039), there were no between-limb differences at 1 year, and there were no differences on any objective measures at 2 years (all P >.05). Mean LSIs across all measures were ≥90%. At 2 years, 84% to 90% of patients were ≥90% on the hop tests, with 72% and 76% of patients having ≥90% for extension and flexion strength, respectively. Two reoperations were undertaken for meniscal tears (7 and 8.5 months), 1 patient (2%) suffered a retear at 7 months, and 2 patients (3%) suffered a contralateral tear (8 and 12 months). Conclusion: This augmented ACLR technique demonstrated good clinical scores, a high rate of return to sport, and low rates of secondary ruptures and contralateral ACL tears at 2 years. Some caution should be noted in interpreting these results, as 15 of 65 patients (23%) were not included in the 2-year follow-up.

KW - anterior cruciate ligament reconstruction

KW - augmentation

KW - clinical outcomes

KW - knee function

KW - retear

KW - return to sport

UR - http://www.scopus.com/inward/record.url?scp=85074249754&partnerID=8YFLogxK

U2 - 10.1177/2325967119879079

DO - 10.1177/2325967119879079

M3 - Article

VL - 7

JO - Orthopaedic Journal of Sports Medicine

JF - Orthopaedic Journal of Sports Medicine

SN - 2325-9671

IS - 10

ER -