Biological enhancement methods may be a viable option for ACL arthroscopic primary repair - A systematic review.

BACKGROUND

Bioactive factors combined with advanced anterior cruciate ligament (ACL) primary repair technology have been used to treat ACL repairs. The current review was conducted to identify whether biological enhancement could enable superior clinical outcome, including side-to-side difference, failure rate, reoperation rate and subjective scores.

HYPOTHESIS

The implementation of ACL primary repair with biological enhancement will provide better clinical outcomes in terms of side-to-side differences, failure rate, reoperation rate and subjective scores than ACL primary repair alone.

MATERIALS AND METHODS

A systematic literature review was performed following PRISMA guidelines by searching all studies reporting outcomes of arthroscopic primary repair with or without biological augmentation published until April 19, 2020, in Medline, PubMed, Embase and the Cochrane Library. Primary metrics were side-to-side differences, failure rate and reoperation rate, as well as measurements of patient-reported outcomes at the last follow-up.

RESULTS

A total of 20 studies were finally included in this work, of which 3 were Grade I (15%), 3 studies were Grade III (15%), and 14 studies were Grade IV (70%) in terms of the level of evidence. There were 729 patients with a mean age of 30 (range: 8-68) years, and the mean follow-up period of which was 38 (range: 3-122) months. At the final follow-up, the postoperative side-to-side differences (the proportion of patients with a side-to-side difference less than 3mm) and patient-report outcomes were significantly better in the biological enhancement group. Nevertheless, there were no significant differences between the two groups in the rate of surgical failure, the rate of revision, or the positive Lachman test or pivot shift test.

CONCLUSION

Biologically enhanced arthroscopic ACL primary repair was superior to ACL primary repair alone in terms of postoperative side-to-side differences (proportion of patients with a side-to-side difference less than 3mm) and patient-reported outcomes. Thus, biologically enhanced arthroscopic ACL primary repair can be preferentially recommended over ACL arthroscopic primary repair alone.

LEVEL OF EVIDENCE

IV, systematic review.