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Primary repair with suture augmentation for proximal anterior cruciate ligament tears: A systematic review with meta-analysis

  • Harmen D. Vermeijden
    Affiliations
    Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States

    Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, The Netherlands

    Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, The Netherlands

    Centre for Orthopedic Research Alkmaar (CORAL) of NorthWest Clinics, Department of Orthopedic Surgery, Alkmaar, The Netherlands
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  • Jelle P. van der List
    Affiliations
    Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States

    Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, The Netherlands

    Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, The Netherlands
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  • Joyce L. Benner
    Affiliations
    Centre for Orthopedic Research Alkmaar (CORAL) of NorthWest Clinics, Department of Orthopedic Surgery, Alkmaar, The Netherlands
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  • Maarten V. Rademakers
    Affiliations
    Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, The Netherlands
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  • Gino M.M.J. Kerkhoffs
    Affiliations
    Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, The Netherlands

    Amsterdam UMC, University of Amsterdam, Academic Center for Evidence based Sports Medicine (ACES), Amsterdam, The Netherlands

    Amsterdam UMC, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, The Netherlands
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  • Gregory S. DiFelice
    Correspondence
    Corresponding author at: Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, United States.
    Affiliations
    Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States
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      Abstract

      Purpose

      To assess the outcomes of arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears with suture augmentation in the literature.

      Methods

      A systematic search was performed using PubMed, EMBASE, and Cochrane for studies reporting on outcomes of primary repair of proximal ACL tears with suture augmentation between 2015 and 2021. Primary outcomes included failure and reoperation rates, whereas secondary outcomes consisted of functional outcomes. Proportion meta-analysis was performed to assess the overall incidence of failure rates. Outcomes of adults and adolescent were reported separately.

      Results

      Thirteen studies with 418 patients were included in this study (mean age 32 years, mean follow-up 2.0 years, 49% male). There were no randomized studies and overall grade of recommendation was weak. Overall failure rate for primary repair with suture augmentation was 8% (95% CI 3.9–14.4), but this was higher for younger patients (17%; 95% CI 2.5–63.9) than for older patients (6%; 95% CI 3.8–8.9). The risk for additional reoperations, complications, or hardware removal was low (all <2%), while functional outcomes were good to excellent (all >80% of maximum score).

      Conclusion

      Current literature shows that primary repair with suture augmentation is a reliable treatment option for proximal ACL tears with a failure rate of 8% and good functional outcome scores at short-term follow-up. Although functional outcomes were good irrespective of age, failure rates were higher in young patients (17% vs 6%, respectively). There is a need for high-quality comparative studies with large group of patients to compare these outcomes with ACL reconstruction.

      Keywords

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