Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

Reinhold Ortmaier; Christian Fink; Wolfgang Schobersberger; Harald Kindermann; Iris Leister; Armin Runer; Caroline Hepperger; Cornelia Blank; Georg Mattiassich

doi:10.1055/a-1019-0949

Sportverletzung · Sportschaden, Inhaltsverzeichnis

Sportverletz Sportschaden 2021; 35(01): 36-44
DOI: 10.1055/a-1019-0949

Originalarbeit

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

Rückkehr zum Sport nach Ruptur des vorderen Kreuzbandes. Eine Matched-paired-Studie nach Kreuzbandnaht mittels Internal Brace und Ersatzplastik mittels Hamstring- oder Quadrizepssehne

Autor*innen

Reinhold Ortmaier

¹Department of Orthopedic Surgery, Institution Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg
Christian Fink

²Gelenkpunkt – Sports and Knee Surgery Innsbruck
Wolfgang Schobersberger

³Institute of Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Tirol Kliniken GmbH, Innsbruck and UMIT Hall, Austria
Harald Kindermann

⁴University of applied science upper Austria
Iris Leister

⁵Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Austria
Armin Runer

⁶Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG) Hall in Tirol; Medical University Innsbruck
Caroline Hepperger

⁷Institute of Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Hall in Tirol
Cornelia Blank

⁷Institute of Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Hall in Tirol
Georg Mattiassich

⁸Trauma Center Linz; Trauma Center Graz; Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg

Abstract

Purpose The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft.

Methods Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (± 5 years), gender, Tegner activity scale (± 1), BMI (± 1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months.

Results Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT.

Conclusion At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. Level of Evidence: Level III Retrospective comparative study.

Zusammenfassung

Hintergrund Der Hintergrund für diese Studie war es, die Sportfähigkeit vor vorderer Kreuzbandruptur und nach operativer Versorgung mittels Kreuzbandnaht durch Internal Brace und Kreuzbandersatzplastik mittels Hamstring- oder Quadrizepssehne zu ermitteln.

Methoden Zwischen 12/2015 und 10/2016 wurden 69 Patienten mit einem mittleren Alter von 33,4 Jahren für diese Matchted-paired-Analyse eingeschlossen. 24 Patienten, die mittels Internal Brace durch Kreuzbandnaht versorgt wurden, sind gemäß ihres Alters (± 5 Jahre), ihres Geschlechts, ihrer Tegner activity scale (± 1), ihres BMI (± 1) und ihrer Begleitverletzungen mit 25 Patienten, welche mittels Hamstringsehnenersatzplastik und 20 Patienten, welche mittels Quadrizepssehnenersatzplastik versorgt wurden, gematched und verglichen worden. Der minimale Nachuntersuchungszeitraum betrug 12 Monate.

Resultate Insgesamt betrug die Return-to-sports-Rate 91,3 %. Zwischen und innerhalb der Gruppen gab es keinen signifikanten Unterschied (p ≥ 0,05) in der Anzahl der Sportdisziplinen und bezüglich des Zeitpunktes der Rückkehr zum Sport. Das Level, auf dem Sport betrieben wurde, änderte sich nicht signifikant (p ≥ 0,05) innerhalb und zwischen den Gruppen. Das Wohlbefinden der Patienten war bei allen Verfahren, sowohl nach Kreuzbandnaht mit Internal Brace als auch nach Kreuzbandrekonstruktion mit Hamstringsehnen und Quadrizepssehne, exzellent.

Schlussfolgerung Im Kurzzeitverlauf konnte gezeigt werden, dass die Naht des vorderen Kreuzbandes mittels Internal Brace die Rückkehr zum Sport ermöglicht und ein subjektives Wohlbefinden bei sportlicher Aktivität, ähnlich wie nach klassischen Rekonstruktionsverfahren mit Hamstring- oder Quadrizepssehne, im untersuchten Patientengut gewährleistet. Evidenzlevel: Level III Retrospektive Matched-paired-Studie.

Key words

ACL repair - ACL reconstruction - internal Brace - hamstring - quadriceps

Schlüsselwörter

VKB-Naht - VKB-Rekonstruktion - Internal Brace - Hamstring - Quadrizeps

Volltext

Referenzen

References
1 Monk AP, Davies LJ, Hopewell S. et al. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database Syst Rev 2016; 4: CD011166
2 Prentice HA, Lind M, Mouton C. et al. Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med 2018; 52 (11) 716-722 . doi:10.1136/bjsports-2017-098674. Epub 2018 Mar 24
3 Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N Engl J Med 2008; 359: 2135-2142
4 Stolarz M, Ficek K, Binkowski M. et al. Bone tunnel enlargement following hamstring anterior cruciate ligament reconstruction: a comprehensive review. Phys Sportsmed 2017; 45: 31-40
5 Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of cl... – PubMed – NCBI. Im Internet: https://www.ncbi.nlm.nih.gov/pubmed/25543249
6 Paterno MV, Rauh MJ, Schmitt LC. et al. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. Am J Sports Med 2014; 42: 1567-1573
7 Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med 1982; 10: 329-335
8 Zimny ML, Schutte M, Dabezies E. Mechanoreceptors in the human anterior cruciate ligament. Anat Rec 1986; 214: 204-209
9 Engebretsen L, Benum P, Sundalsvoll S. Primary suture of the anterior cruciate ligament. A 6-year follow-up of 74 cases. Acta Orthop Scand 1989; 60: 561-564
10 Feagin JA, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 1976; 4: 95-100
11 Odensten M, Lysholm J, Gillquist J. Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up. Acta Orthop Scand 1984; 55: 270-272
12 Wilson WT, Hopper GP, Byrne PA. et al. Anterior Cruciate Ligament Repair with Internal Brace Ligament Augmentation. Surg Technol Int 2016; XXIX: 273-278
13 Bieri KS, Scholz SM, Kohl S. et al. Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work. Injury 2017; 48: 1243-1248
14 Büchler L, Regli D, Evangelopoulos DS. et al. Functional recovery following primary ACL repair with dynamic intraligamentary stabilization. The Knee 2016; 23: 549-553
15 Eggli S, Kohlhof H, Zumstein M. et al. Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2015; 23: 1215-1221
16 Eggli S, Röder C, Perler G. et al. Five year results of the first ten ACL patients treated with dynamic intraligamentary stabilisation. BMC Musculoskelet Disord 2016; 17: 105
17 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop 1985; 43-49
18 Naal FD, Fischer M, Preuss A. et al. Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 2007; 35: 1688-1695
19 Ortmaier R, Pichler H, Hitzl W. et al. Return to Sport After Short-Stem Total Hip Arthroplasty. Clin J Sport Med Off J Can Acad Sport Med 2019; 29 (06) 451-458
20 Salzmann GM, Ahrens P, Naal FD. et al. Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 2009; 37: 312-318
21 Fink C, Herbort M, Abermann E. et al. Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech 2014; 3: e509-e513
22 Runer A, Wierer G, Herbst E. et al. There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018; 26: 605-614
23 Ateschrang A, Ahmad SS, Stöckle U. et al. Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018; 26: 589-595
24 Scapinelli R. Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat N Y N 1997; 10: 151-162
25 Steadman JR, Matheny LM, Briggs KK. et al. Outcomes following healing response in older, active patients: a primary anterior cruciate ligament repair technique. J Knee Surg 2012; 25: 255-260
26 Vavken P, Fleming BC, Mastrangelo AN. et al. Biomechanical outcomes after bioenhanced anterior cruciate ligament repair and anterior cruciate ligament reconstruction are equal in a porcine model. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2012; 28: 672-680
27 Kohl S, Stock A, Ahmad SS. et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury 2015; 46: 724-728
28 Evangelopoulos DS, Kohl S, Schwienbacher S. et al. Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2017; 25: 2414-2419
29 Kay J, Memon M, Marx RG. et al. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018; 26: 1019-1036
30 Dunn WR, Spindler KP. MOON Consortium. Predictors of activity level 2 years after anterior cruciate ligament reconstruction (ACLR): a Multicenter Orthopaedic Outcomes Network (MOON) ACLR cohort study. Am J Sports Med 2010; 38: 2040-2050
31 Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2006; 14: 1021-1028
32 Ardern CL, Taylor NF, Feller JA. et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48: 1543-1552
33 Ardern CL, Webster KE, Taylor NF. et al. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 2011; 39: 538-543
34 Webster KE, Feller JA. Expectations for Return to Preinjury Sport Before and After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47: 578-583
35 Henle P, Bieri KS, Brand M. et al. Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018; 26: 1182-1189
36 Wiggins AJ, Grandhi RK, Schneider DK. et al. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2016; 44: 1861-1876
37 Christino MA, Fantry AJ, Vopat BG. Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg 2015; 23: 501-509
38 Kvist J, Ek A, Sporrstedt K. et al. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2005; 13: 393-397
39 McCullough KA, Phelps KD, Spindler KP. et al. Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med 2012; 40: 2523-2529