Suture-augmented anterior cruciate ligament repair leads to comparable short-term function but a modestly higher re-rupture risk than anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

PURPOSE

The aim of this study was to conduct a meta-analysis of the current literature on the treatment of anterior cruciate ligament (ACL) rupture with suture-augmented ACL repair (SA-ACLRep) compared to the gold standard ACL reconstruction (ACLR). The meta-analysis was designed to provide clinical outcomes, including re-rupture rates (as primary end point), knee stability, functional outcomes, return to sport and complications.

METHODS

A systematic literature search was conducted in PubMed, Embase and the Cochrane Library up to 30 August 2024, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative clinical studies were included if they conducted a comparative analysis on the clinical outcome of SA-ACLRep versus ACLR with a minimum of 2 years of follow-up (FU). The primary outcome was ACL re-rupture rate; secondary outcomes included complications, knee stability (arthrometer measurements), patient-reported outcome measures (PROMs) and return-to-sport. A random effects model (based on the restricted maximum likelihood method) was used for all pooled analyses.

RESULTS

Four studies met the inclusion criteria and included 687 patients (276 SA-ACLRep and 411 ACLR). There was no statistically significant difference between the two groups in terms of re-rupture rates (11.5% with SA-ACLRep and 8.4% with ACLR;  = 0.094). PROMs, including International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score subscales, Lysholm, visual analogue scale pain, Single Assessment Numeric Evaluation and Tegner scores, showed no significant differences between SA-ACLRep and ACLR. No significant differences were found in return to sport rates (72.3% with SA-ACLRep and 65.0% with ACLR;  = 0.541) or timing (mean difference = -0.93 months [95% confidence interval: -2.54, 0.69]; p = 0.261).

CONCLUSIONS

SA-ACLRep with internal bracing and ACLR showed comparable short-term (≥24 months) FU results, with no statistically significant differences observed in re-rupture rates, PROMs or return-to-play rates. This may suggest that SA-ACLRep may be a viable alternative for appropriately indicated proximal ACL tears. Heterogeneity in study design, the small number of studies included, the repair timing and reconstruction techniques limit the generalizability of the results.

LEVEL OF EVIDENCE

Level III, meta-analysis of Levels II and III studies.