Dataset Information

Suture Augmentation: An Alternative to Reconstruction for Incomplete Posterior Cruciate Ligament Injuries in the Multiple Ligament-Injured Knee.

ABSTRACT: Treatment of posterior cruciate ligament injuries remains controversial, particularly in the case of partial or incomplete tears in the context of a multiple ligament-injured knee. Suture augmentation, or internal bracing, has been shown in other ligament and tendon repairs or reconstructions to provide stable biomechanics and facilitate early return to activity. In the knee, suture augmentation has previously been used for the treatment of medial collateral ligament tears and in the support of anterior cruciate ligament reconstructions. We describe our arthroscopic technique for suture augmentation of incomplete posterior cruciate ligament injuries.

SUBMITTER: Trasolini NA

PROVIDER: S-EPMC5989691 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Suture Augmentation: An Alternative to Reconstruction for Incomplete Posterior Cruciate Ligament Injuries in the Multiple Ligament-Injured Knee.

Trasolini Nicholas A NA Rick Hatch George F GF

Arthroscopy techniques 20180219 3

Treatment of posterior cruciate ligament injuries remains controversial, particularly in the case of partial or incomplete tears in the context of a multiple ligament-injured knee. Suture augmentation, or internal bracing, has been shown in other ligament and tendon repairs or reconstructions to provide stable biomechanics and facilitate early return to activity. In the knee, suture augmentation has previously been used for the treatment of medial collateral ligament tears and in the support of ...[more]

PMID: 29881695

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Project description:Many techniques have been described for posterior cruciate ligament (PCL) reconstruction, but residual laxity remains an ongoing challenge. Suture or tape augmentation during ligament reconstruction has become a popular option to prevent graft elongation but comes at the expense of additional costs due to implants for augment fixation, and concern for stress shielding of the graft if the augment and graft are not equally tensioned. We introduce a technique for postless tape augmentation during allograft PCL reconstruction that allows for equal tensioning of graft and augment through the use of a sheath and screw construct without the need for additional implants for augment fixation. Technique Video Video 1 This technique demonstrates a case using postless tape augmentation during posterior cruciate ligament (PCL) reconstruction. The tibial and femoral tunnels are first created with the assistance of an accessory posteromedial portal and drilling under direct arthroscopic and fluoroscopic visualization. An Achilles tendon allograft with a bone plug is used as the allograft. The bone plug and soft tissue are shaped to fit within 10-mm tunnels. A 2.5-mm suture tape (Dynatape, Depuy-Mitek, Johnson and Johnson, Raynham, MA) is then passed through a 2.5-mm drill hole in the bone block, which will be used as the postless augment for the graft. High-tensile strength suture (#2 Orthocord, Depuy-Mitek, Johnson and Johnson) is then passed through the end of the bone block and two additional high-tensile strength sutures (#2 Orthocord, Depuy-Mitek, Johnson and Johnson) are sutured into the soft tissue portion of the graft, in a Krackow suture pattern, to assist with graft passage. The graft is then passed through the tunnels in a retrograde fashion with the assistance of a shuttling suture. Once the graft has been passed out the femur, and the bone plug is fully seated in the most proximal extent of the tibial tunnel, it is secured in place using a metal interference screw, which is confirmed fluoroscopically. Final fixation of the graft is then performed with the knee placed at 90° of flexion, application of an anterior drawer, and insertion of a screw and sheath into the tunnel. It is essential to maintain tension on the allograft and tape during all steps of tibial screw and sheath placement. No additional fixation is required in the femur, as both the allograft and tape are well secured with the sheath and screw.

Project description:PurposeTo assess failure rate, outcomes, and patient satisfaction in patients who underwent anterior cruciate ligament (ACL) repair with suture augmentation for clinical instability and proximal avulsion of the ACL.MethodsWe retrospectively reviewed consecutive suture-augmented ACL repairs performed by a single surgeon between January 2014 and June 2016 for proximal ACL avulsion. Patients were included if they were at least 24 months postoperative from repair surgery. Patients were excluded from the study if they underwent primary ACL reconstruction instead of repair or if they had a concomitant multiligamentous knee injury. Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), Veterans RAND-12 (VR-12), Marx Activity, and Single Assessment Numeric Evaluation data were collected.ResultsOf 172 patients who underwent ACL surgery between January 2014 and June 2016, 28 (16%) with Sherman type I or II ACL tears or high-grade partial avulsion with clinical instability underwent ACL repair with suture augmentation. One patient was not available for follow-up. The 27 patients were age 27.4 ± 8.6 years, 18 males (66.7%), and 2.8 ± 0.7 years follow-up (range, 2.0-3.8 years). Of these 27 patients, 4 recurrent ACL injuries (14.8%) required revision to reconstruction. The remaining 23 patients had successful ACL repair with no clinical instability and no subjective complaints at final follow-up. Final scores were KOOS 83.7 ± 12.8, Marx 8.6 ± 4.0, VAS 1.1 ± 1.8, physical VR-12 53.6 ± 5.2, mental VR-12 53.1 ± 8.1, and Single Assessment Numeric Evaluation 83.0 ± 12.9. In the 11 patients with baseline data, significant improvements were observed in composite KOOS (50.4 ± 11.5 to 85.7 ± 8.4; P < .001; VAS: 3.9 ± 2.6 to 0.8 ± 0.8; P = .002; and physical VR-12: 39.9 ± 6.5 to 55.5 ± 3.3; P < .001). All 11 patients (100%) met or exceeded the KOOS composite minimum clinically important difference (mean 34.0 increase).ConclusionsIn patients with proximal ACL avulsion, arthroscopic primary ACL repair with suture augmentation demonstrated high functional outcome and improved patient-reported outcomes at 2-year follow-up. The rate of graft failure was 15%.Level of evidenceLevel IV, therapeutic case series.

Dataset Information

Suture Augmentation: An Alternative to Reconstruction for Incomplete Posterior Cruciate Ligament Injuries in the Multiple Ligament-Injured Knee.

Publications

Suture Augmentation: An Alternative to Reconstruction for Incomplete Posterior Cruciate Ligament Injuries in the Multiple Ligament-Injured Knee.

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