Anterior cruciate ligament repair augmented with dynamic intraligamentary stabilization is equivalent to hamstring autograft reconstruction at short and mid-term follow-up: a systematic review

Abstract

Purpose

To compare clinical outcomes, knee stability and complication, failure and revision rates following anterior cruciate ligament repair (ACLr) with dynamic intraligamentary stabilization (DIS) vs. anterior cruciate ligament reconstruction (ACLR) with hamstring autograft for primary ACL ruptures at short and mid-term follow-up.

Methods

A PRISMA-compliant systematic review of PubMed/MEDLINE and Scopus was performed. Studies that evaluated patients undergoing ACLr with DIS or ACLR with hamstring autograft were considered for inclusion. Studies were excluded if patients were affected by concomitant meniscal, ligamentous, or chondral injuries needing surgical treatment due to their potential confounding effect on postoperative outcomes. The RoB-2 tool was utilized to assess the risk of bias in the included studies. The quality of available evidence was rated according to GRADE recommendations. The study protocol was registered in the PROSPERO database (ID: CRD42023394558).

Results

Five randomized controlled trials comparing the outcomes of ACLr with DIS vs. ACLR with hamstring autograft met the inclusion criteria. No major differences in terms of patient-reported outcomes (International Knee Documentation Committee subjective form [IKDC], Lysholm score, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score, visual analogue scale satisfaction), as well as rates of complications, revisions, and failures were found in included studies at all timepoints. Repair showed higher IKDC scores at 5 years in one study, while ACLR displayed significantly increased knee stability at 6 months and 5 years in two different studies, although the clinical relevance of these differences is doubtful.

Conclusions

The results of this study suggest that ACLr with DIS is not inferior to ACLR with hamstring autograft in terms of rates of clinical outcomes, knee stability, risk of failure, complications, and revision surgery. Therefore, ACLr with DIS may be a viable alternative to ACLR with hamstring autograft in selected patients.