Arthroscopic Anterior Cruciate Ligament Repair With Suture Augmentation Provides Good to Excellent Midterm Functional Outcomes Despite Clinically Relevant Revision Rates.

Abstract

Purpose: To evaluate midterm functional outcomes after anterior cruciate ligament (ACL) repair with suture augmentation and to determine whether concomitant injuries influence patient-reported outcomes.

Methods: This retrospective single-center cohort study included patients undergoing arthroscopic ACL repair with suture augmentation between January 2017 and March 2019. Eligible patients had proximal ACL tears (Sherman type I-II) with adequate tissue quality at a minimum 6-year follow-up. Patient-reported outcome measures included the International Knee Documentation Committee, Lysholm score, Tegner activity score, and forgotten joint score. Multivariate regression analysis was performed to identify predictors of postoperative outcomes. Clinically meaningful improvement was assessed using the minimal clinically important difference.

Results: Of 93 patients, 80 (86%) were available for follow-up. Thirteen patients (16.3%) underwent revision surgery, all consisting of ACL reconstruction, at a median time of 35 months (interquartile range [IQR] 8-49) and were excluded, leaving 67 patients for evaluation. At a median follow-up of 79 months (IQR 75-97), median International Knee Documentation Committee was 94 (IQR 71-100); Lysholm score, 92 (IQR 74-100); and forgotten joint score, 86 (IQR 65-94). Median Tegner activity score decreased from 7 (IQR 4-10) preinjury to 6 (IQR 4-9) postoperatively (P = .03), remaining within the minimal clinically important difference in 74.6% of patients. Concomitant meniscal (n = 41) and ligamentous injuries (n = 63) were addressed intraoperatively and did not significantly affect patient-reported outcome measures. Delayed surgery was the only independent predictor of lower postoperative Tegner activity scores (β = -0.79, P = .025).

Conclusions: Arthroscopic ACL repair with suture augmentation achieved good to excellent midterm functional outcomes in a 6-year follow-up, with 74.6% of patients maintaining activity levels within the minimal clinically important difference threshold. However, the revision rate of 16.3% remains clinically relevant. Concomitant ligamentous and meniscal lesions of low severity did not result in inferior patient-reported outcomes in this cohort.

Level of evidence: Level IV, retrospective therapeutic case series.