Anterior cruciate ligament reconstruction with suture tape augmentation in the high-risk, young population

Abstract

Introduction: This study evaluated patient-reported outcome measures and reinjury rates in higher-risk adolescents and young adults aged 14-25 years old following Anterior Cruciate Ligament reconstruction using autograft with suture tape augmentation (SA ACLR).

Materials and methods: We performed a retrospective case series of patients aged 14-25 who underwent SA ACLR by a single surgeon between 2016 and 2020. After a minimum of 2 years of follow-up, data was collected on reinjury and patient reported outcome measures, including Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), Single Assessment Numeric Evaluation (SANE), and Visual Analog Pain Scale (VAPS).

Results: 27 patients were identified. 4 were lost to follow-up, and 23 met inclusion criteria (11 male, 12 female). Average age was 20, and average follow-up was 2.5 years. Failure rate was 8.7%, with two patients requiring revision ACL reconstruction. One patient required two additional meniscal operations with intraoperative findings demonstrating maintenance of an intact ACL. Postoperative patient-reported outcomes measures (PROMs) were obtained for the patients who did not require additional surgery (n = 20), and preoperative PROMs were available for 16 of these patients. Postoperatively, patients reported a mean VAPS of 0.74 ± 1.27, MARS of 8.05 ± 5.58, and SANE of 83.05 ± 16.47. Mean KOOS was 86.92 ± 11.77 with subscores Pain of 86.94 ± 12.94, Symptoms of 82.16 ± 14.96, ADL of 95.81 ± 8.10, Sport of 75.61 ± 21.52, and QOL of 70.64 ± 22.04. Paired t-tests demonstrated significant improvements in VAPS, SANE, and KOOS outcomes following surgery. Patients were significantly less active postoperatively as reported by the MARS. A multivariable regression analysis showed that increased age predicted poorer postoperative KOOS Pain outcomes, and female sex predicted inferior KOOS Pain and Sport outcomes.

Conclusion: SA ACLR is a safe and effective surgical technique in the high failure risk young adult demographic, with a low reinjury rate and acceptable KOOS scores. Patients were active with minimal pain at minimum two years of follow-up. Female sex was a risk factor for poorer outcomes in this population.

Keywords: ACL; ACL reconstruction; Arthroscopy; Sports injuries; Suture augmentation.