Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization.

Evangelopoulos, Dimitrios Stergios; Kohl, Sandro; Schwienbacher, Stefan; Gantenbein, Benjamin; Exadaktylos, Aristomenis; Ahmad, Sufian (2015). Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization. Knee surgery, sports traumatology, arthroscopy, 25(8), pp. 2414-2419. Springer 10.1007/s00167-015-3838-7

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PURPOSE Dynamic intraligamentary stabilization was recently proposed as an option for the treatment of acute ACL ruptures. The aim of this study was to investigate the feasibility of the procedure in mid-substance ACL ruptures and examine whether the additional application of a bilayer collagen I/III membrane would provide for a superior outcome. METHODS The study group consisted of patients presenting with a mid-substance ACL rupture undergoing dynamic intraligamentary stabilization using the Ligamys™ device along with application of a collagen I/III membrane to the surface of the ACL (group A, n = 23). The control group comprised a matched series of patients presenting with a mid-substance ACL rupture also treated by dynamic intraligamentary stabilization Ligamys™ repair, however, without additional collagen application (group B, n = 33). Patients were evaluated preoperatively and at 24-month follow-up for stability as well as Tegner and Lysholm scores. Knee laxity was measured as a difference in anterior translation (ΔAP) and pivot shift. Any events occurring during the follow-up period of 24 months were documented. Logistic regression of complications was performed, and adjustment undertaken where necessary. RESULTS A high total complication rate of 78.8 % was noted in group B, compared to group A (8.7 %) (p = 0.002). The addition of a collagen membrane was the only independent prognostic factor associated with reduced complications (OR 8.0, CI 2.0-32.2, p = 0.003, for collagen-free treatment). In group B, 6 patients suffered a re-rupture with subsequent instability requiring secondary hamstring reconstruction surgery, and 11 developed extension loss requiring arthroscopic debridement, whilst in group A, 2 patients required arthroscopic debridement for loss of exension, with no further encountered complication. Median Lysholm score was significantly higher in group A compared to group B (median 100 range 93-100 vs median 95 range 60-100, p = 0.03) at final follow-up. CONCLUSIONS A high complication rate following ACL Ligamys™ repair of mid-substance ruptures was noted. Application of a collagen membrane to the surface of the ACL resulted in a reduced incidence of extension deficit and re-ruptures. The results indicate that solitary ACL Ligamys™ repair does not present an appropriate treatment modality for mid-substance ACL ruptures. Collage application proved to provide healing benefits with superior clinical outcome after ACL repair. LEVEL OF EVIDENCE Case control study, Level III.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute for Surgical Technology & Biomechanics ISTB

UniBE Contributor:

Evangelopoulos, Dimitrios Stergios; Kohl, Sandro; Schwienbacher, Stefan; Gantenbein, Benjamin; Exadaktylos, Aristomenis and Ahmad, Sufian

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

0942-2056

Publisher:

Springer

Language:

English

Submitter:

Benjamin Gantenbein

Date Deposited:

19 Nov 2015 11:54

Last Modified:

30 Jul 2017 01:59

Publisher DOI:

10.1007/s00167-015-3838-7

PubMed ID:

26564213

Uncontrolled Keywords:

ACL; ACL reconstruction; DIS; Dynamic intraligamentary stabilization; Knee; Ligamys

BORIS DOI:

10.7892/boris.73190

URI:

https://boris.unibe.ch/id/eprint/73190

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