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      Bridge enhanced ACL repair vs. ACL reconstruction for ACL tears: A systematic review and meta-analysis of comparative studies

      review-article
      1 , * , , 2 , 3 , 1 , 2 , 3
      SICOT-J
      EDP Sciences
      Bridge enhanced ACL repair, ACL reconstruction, ACL repair, ACL tear, ACL graft

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          Abstract

          Introduction: Anterior cruciate ligament (ACL) tear is one of the most frequent ligamentous injuries. The gold standard for ACL tears is autograft reconstruction. However, ACL repair has regained enthusiasm with more recent results showing comparable outcomes to its reconstructive counterpart. Methods: PubMed, Cochrane, and Google Scholar (pp. 1–20) were searched until November 2022. The clinical outcomes consisted of the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), the side-to-side difference in Anteroposterior (AP) knee laxity, the forces of the hamstring, quadriceps, and hip abduction as well as hopping tests. Results: Only two studies were included in this meta-analysis. ACL repair was shown to have better Hamstrings strength. The rest of the analyzed outcomes were comparable. Discussion: This is the first meta-analysis comparing these two treatments. The ACL repair showed no differences in muscle strength (quadriceps and hip abductors), postoperative knee scores, and knee joint laxity when compared to ACL reconstruction. However, it showed better hamstring strength. Further randomized clinical studies will be needed to compare both of these techniques.

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          Most cited references29

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          Isolated tear of the anterior cruciate ligament: 5-year follow-up study.

          During the period 1967 to 1971, 64 cadets at the United States Military Academy, West Point, New York, had surgical repair for isolated tear of the anterior cruciate ligament. In a 5-year follow-up study to determine the functional impairment, present disability, and reinjury to the knee, 32 of the 64 patients were located and evaluated by radiographic examination and either by interview or by questionnaire. Twenty-two were commissioned to full duty. 23 had attended ranger or airborne school, and 16 had been in combat. Impairment of ordinary activities was noted by 12 and impairment of athletic endeavors by 24; pain by 71%; swelling by 66%; stiffness by 71%; and instability by 94%. Seventeen of the 32 had had a significant reinjury after the repair of the anterior cruciate ligament. Clinically, we can diagnose the isolated tear of the anterior cruciate ligament by four essential ingredients--a pop at time of injury, inability to continue participation, gross swelling of knee, and maximal swelling within 12 hr. The mechanism of injury is usually deceleration and change of direction, not contact with another player. The follow-up study on this small series indicates that the patients have progressive deterioration of the knee.
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            Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

            Background: Preclinical studies suggest that for complete midsubstance anterior cruciate ligament (ACL) injuries, a suture repair of the ACL augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair [BEAR]) may be a viable alternative to ACL reconstruction (ACLR). Hypothesis: We hypothesized that patients treated with BEAR would have a noninferior patient-reported outcomes (International Knee Documentation Committee [IKDC] Subjective Score; prespecified noninferiority margin, –11.5 points) and instrumented anteroposterior (AP) knee laxity (prespecified noninferiority margin, +2-mm side-to-side difference) and superior muscle strength at 2 years after surgery when compared with patients who underwent ACLR with autograft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were enrolled and underwent surgery within 45 days of injury. Patients were randomly assigned to receive either BEAR (n = 65) or autograft ACLR (n = 35 [33 with quadrupled semitendinosus-gracilis and 2 with bone–patellar tendon–bone]). Outcomes—including the IKDC Subjective Score, the side-to-side difference in instrumented AP knee laxity, and muscle strength—were assessed at 2 years by an independent examiner blinded to the procedure. Patients were unblinded after their 2-year visit. Results: In total, 96% of the patients returned for 2-year follow-up. Noninferiority criteria were met for both the IKDC Subjective Score (BEAR, 88.9 points; ACLR, 84.8 points; mean difference, 4.1 points [95% CI, –1.5 to 9.7]) and the side-to-side difference in AP knee laxity (BEAR, 1.61 mm; ACLR, 1.77 mm; mean difference, –0.15 mm [95% CI, –1.48 to 1.17]). The BEAR group had a significantly higher mean hamstring muscle strength index than the ACLR group at 2 years (98.2% vs 63.2%; P < .001). In addition, 14% of the BEAR group and 6% of the ACLR group had a reinjury that required a second ipsilateral ACL surgical procedure (P = .32). Furthermore, the 8 patients who converted from BEAR to ACLR in the study period and returned for the 2-year postoperative visit had similar primary outcomes to patients who had a single ipsilateral ACL procedure. Conclusion: BEAR resulted in noninferior patient-reported outcomes and AP knee laxity and superior hamstring muscle strength when compared with autograft ACLR at 2-year follow-up in a young and active cohort. These promising results suggest that longer-term studies of this technique are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier)
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              Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management.

              Anterior cruciate ligament (ACL) injuries are the most common ligament injury in the United States. These injuries can be career ending for athletes and severely disabling for all individuals. Our objectives are to review the epidemiology of these injuries, as well as ACL biomechanics, anatomy, and nonsurgical and surgical management so that generalists as well as sports medicine physicians, orthopedists, and others will have a better understanding of this serious injury as well as choices in its management. PubMed was used to identify relevant articles. These articles were then used to identify other sources. Anterior cruciate ligament injuries occur more commonly in women than in men due to a variety of anatomical factors. The ACL consists of 2 major bundles, the posterolateral and the anteromedial bundles. Forces transmitted through these bundles vary with knee-joint position. Some patients with ACL injuries may not be candidates for surgery because of serious comorbid medical conditions. However, without surgical repair, the knee generally remains unstable and prone to further injury. There are a variety of surgical decisions that can influence outcomes. Single-bundle versus double-bundle repair, whether to leave the ruptured ACL remnant in the knee, the selection of the graft tissue, graft placement, and whether to use the transtibial, far anteromedial portal, or tibial tunnel-independent technique are choices that must be made. With a sound knowledge of the anatomy and kinetics of the knee, newer improved surgical techniques have been developed that can restore proper knee function and have allowed many athletes to resume their careers. These new techniques have also limited the disability in nonathletes.
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2023
                13 April 2023
                : 9
                : 8
                Affiliations
                [1 ] Division of Orthopaedic Surgery and Sports Medicine, McGill University Health Centre 845 Sherbrooke Street Montreal H4A 3J1 Quebec Canada
                [2 ] Department of Orthopedic Surgery, Lebanese American University Medical Center‑Rizk Hospital, Lebanese American University School of Medicine Zahar Street 11-3288 Achrafieh Lebanon
                [3 ] Hôtel Dieu de France, Orthopedic Department, Alfred Naccache Boulevard 166830 Beirut Lebanon
                Author notes
                [* ]Corresponding author: jad.mansour09@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-7147-5076
                http://orcid.org/0000-0002-9256-9952
                Article
                sicotj230014 10.1051/sicotj/2023007
                10.1051/sicotj/2023007
                10092275
                37042698
                afedb38d-9313-4a75-b8a0-e37100ff081f
                © The Authors, published by EDP Sciences, 2023

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 February 2023
                : 19 March 2023
                Page count
                Figures: 7, Tables: 1, Equations: 0, References: 29, Pages: 9
                Categories
                Review Article
                Knee

                bridge enhanced acl repair,acl reconstruction,acl repair,acl tear,acl graft

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