Abstract | May 5, 2023

Analysis of Graft Types used with Internal Brace Augmentation for ACL Reconstruction: A Systematic Review

Connor Maginnis, BS

Cooper Root, BS, Medical Student, 2nd Year, University of Kansas School of Medicine, Kansas City, KS; Julie H. Schiavo, MLIS, Louisiana State University Health Science Center, New Orleans, La; Victoria K. Ierulli, MS, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, La; Bryan Vopat, MD, Department of Orthopaedic Surgery, University of Kansas School of Medicine, Kansas City, KS; Mary K. Mulcahey, MD, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, La

Learning Objectives

  1. Discuss the utility and advantages of suture tape augmentation with different graft types for ACL reconstruction
  2. Consider suture tape augmentation as an effective alternative method for future ACL reconstructions

Abstract

Background: New techniques are being created to decrease the failure rate of ACL grafts and prevent revision surgery. One such technique involves high strength suture tape, also referred to as an InternalBrace™ (Arthrex Inc.). Recent literature has highlighted the overall use of suture tape for ACL reconstruction, but no study has compared suture tape augmentation between graft types. The purpose of this study was to determine the potential benefits of augmenting with an internal brace depending on the type of graft (ie BPTB, quadriceps, hamstring). Methods: An online search of MEDLINE (Ovid), Embase, Scopus, Web of Science Core Collection, clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials (CENTER) was performed in March 2022 to identify all articles related to suture tape augmentation of ACL grafts. Results: 926 studies were identified, 10 of which met inclusion criteria. 5 studies used hamstring tendon (HT) (50%), 3 used quad tendon (QT) (10%), 1 used bone-patellar tendon-bone (BPTB) (10%), and 1 study used both HT and QT grafts (10%). HT grafts augmented with suture tape decreased dynamic and peak elongation (15-56%), increased load to failure (20-77%) and increased initial and final dynamic stiffness (31-47%). There was no significant difference in post-operative physical exam findings, except suture tape augmented grafts had significantly less laxity post-surgery compared to hamstring tendon alone (0.8 vs 1.9 mm). QT grafts increased graft strength with normal graft incorporation and graft-to-bone healing at 6-month post-surgical histological assessment. One study showed 9 out of 11 patients (82%) returning to pre-injury activity level. There was no difference in negative outcomes, along with higher KOOS scores reported in suture tape augmented patients. The BPTB graft bone model decreased cyclic displacement by 31% (2.9 ± 0.8 mm), increased load (758 ± 128 N), and stiffness (156 ± 23 N/mm) in the suture tape augmentation group.

Conclusion: The findings of this study indicate that the use of HT, QT, and BPTB grafts with suture tape augmentation demonstrates an effective method for ACL reconstruction based on the biomechanical and clinical outcomes. Suture tape augmentation should be considered for the future of all ACL reconstruction procedures.



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