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Dynamic intraligamentary stabilization for ACL repair: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

It was the aim to assess all published original research dealing with dynamic repair of the anterior cruciate ligament (ACL) and to provide a semi-quantitative analysis of clinical outcome reports.

Methods

Both OVIS and MEDLINE databases were utilized for allocation of articles. All preclinical and clinical studies related to dynamic intraligamentary stabilization (DIS) were identified. Results were tabulated and semi-quantitative analysis performed.

Results

Twenty-three articles related to DIS were identified. The predominant level of evidence ranged between II and IV, with only one level I study. Reported failure rates ranged between 4% and 13.6%. Most clinical studies only reported revision rates without referring to failure of restoring stability. Highest success was achieved with proximal ACL ruptures. Both the level of physical activity and  patient age have been found to influence the risk of failure.

Conclusion

There is sufficient evidence to support that DIS repair may be an effective modality for the treatment of acute proximal tears of the ACL. However, comparative studies are lacking. Upcoming studies should compare the technique to ACL reconstruction with failure as an endpoint. Comparison to rigid methods of proximal fixation is also necessary to justify the need for dynamic fixation. Overall, there is evidence to suggest the potential space for ACL repair in the decision tree for individualized treatment planning. The best outcome will be in the hands of the best patient selectors.

Level of evidence

IV.

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References

  1. Ahmad SS, Evangelopoulos DS, Abbasian M, Roder C, Kohl S (2014) The hundred most-cited publications in orthopaedic knee research. J Bone Joint Surg Am 96:e190

    Article  PubMed  Google Scholar 

  2. Ahmad SS, Meyer JC, Krismer AM, Ahmad SS, Evangelopoulos DS, Hoppe S et al (2017) Outcome measures in clinical ACL studies: an analysis of highly cited level I trials. Knee Surg Sports Traumatol Arthrosc 25:1517–1527

    Article  PubMed  Google Scholar 

  3. Ateschrang A, Ahmad SS, Stockle U, Schroeter S, Schenk W, Ahrend MD (2018) Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation. Knee Surg Sports Traumatol Arthrosc 26:589–595

    Article  PubMed  Google Scholar 

  4. Barrett DS (1991) Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br 73:833–837

    Article  PubMed  CAS  Google Scholar 

  5. Bieri KS, Scholz SM, Kohl S, Aghayev E, Staub LP (2017) Dynamic intraligamentary stabilization versus conventional ACL reconstruction: a matched study on return to work. Injury 48:1243–1248

    Article  PubMed  Google Scholar 

  6. Buchler L, Regli D, Evangelopoulos DS, Bieri K, Ahmad SS, Krismer A et al (2016) Functional recovery following primary ACL repair with dynamic intraligamentary stabilization. Knee 23:549–553

    Article  PubMed  Google Scholar 

  7. Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29:1566–1571

    Article  PubMed  Google Scholar 

  8. Drogset JO, Grøntvedt T, Robak OR, Mølster A, Viset AT, Engebretsen L (2006) A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate ligament. JBJS 88:944–952

    Article  Google Scholar 

  9. Eggli S, Kohlhof H, Zumstein M, Henle P, Hartel M, Evangelopoulos DS et al (2015) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23:1215–1221

    Article  PubMed  CAS  Google Scholar 

  10. Eggli S, Roder C, Perler G, Henle P (2016) 5 years results of the first ten ACL patients treated with dynamic intraligamentary stabilisation. BMC Musculoskelet Disord 17:105

    Article  PubMed  PubMed Central  Google Scholar 

  11. Evangelopoulos DS, Kohl S, Schwienbacher S, Gantenbein B, Exadaktylos A, Ahmad SS (2017) Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization. Knee Surg Sports Traumatol Arthrosc 25:2414–2419

    Article  PubMed  Google Scholar 

  12. Feagin JA Jr, Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4:95–100

    Article  PubMed  Google Scholar 

  13. Haberli J, Henle P, Acklin YP, Zderic I, Gueorguiev B (2016) Knee joint kinematics with dynamic augmentation of primary anterior cruciate ligament repair—a biomechanical study. J Exp Orthop 3:29

    Article  PubMed  PubMed Central  Google Scholar 

  14. Haberli J, Jaberg L, Bieri K, Eggli S, Henle P (2018) Reinterventions after dynamic intraligamentary stabilization in primary anterior cruciate ligament repair. Knee 25:271–278

    Article  PubMed  Google Scholar 

  15. Häberli J, Voumard B, Kösters C, Delfosse D, Henle P, Eggli S et al (2018) Implant preloading in extension reduces spring length change in dynamic intraligamentary stabilization: a biomechanical study on passive kinematics of the knee. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5002-7

    Article  PubMed  Google Scholar 

  16. Hefti E, Müller W, Jakob RP, Stäubli H-U (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surgery, Sports Traumatology. Arthroscopy 1:226–234

    CAS  Google Scholar 

  17. Henle P, Bieri KS, Brand M, Aghayev E, Bettfuehr J, Haeberli J et al (2018) Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 26:1182–1189

    Article  PubMed  Google Scholar 

  18. Henle P, Bieri KS, Haeberli J, Arnout N, Victor J, Herbort M et al (2018) Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-4847-0

    Article  PubMed  Google Scholar 

  19. Henle P, Röder C, Perler G, Heitkemper S, Eggli S (2015) Dynamic intraligamentary stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord 16:27

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hoogeslag RAG, Brouwer RW, Huis In ‘t Veld R, Stephen JM, Amis AA (2018) Dynamic augmentation restores anterior tibial translation in ACL suture repair: a biomechanical comparison of non-, static and dynamic augmentation techniques. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-4848-z

    Article  PubMed  Google Scholar 

  21. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 5:13

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H et al (2014) A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study. Knee 21:477–480

    Article  PubMed  Google Scholar 

  23. Kohl S, Evangelopoulos DS, Kohlhof H, Hartel M, Bonel H, Henle P et al (2013) Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique. Knee Surg Sports Traumatol Arthrosc. 21:599–605

    Article  PubMed  Google Scholar 

  24. Kohl S, Evangelopoulos DS, Schär MO, Bieri K, Müller T, Ahmad SS (2016) Dynamic intraligamentary stabilisation: initial experience with treatment of acute ACL ruptures. Bone Joint J. 98-B:793–798

    Article  PubMed  CAS  Google Scholar 

  25. Kosters C, Herbort M, Schliemann B, Raschke MJ, Lenschow S (2015) Dynamic intraligamentary stabilization of the anterior cruciate ligament. Operative technique and short-term clinical results. Unfallchirurg. 118:364–371

    Article  PubMed  CAS  Google Scholar 

  26. Krismer AM, Gousopoulos L, Kohl S, Ateschrang A, Kohlhof H, Ahmad SS (2017) Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation. Knee Surg Sports Traumatol Arthrosc 25:3923–3928

    Article  PubMed  Google Scholar 

  27. May C, Gueorguiev B, Heuberger R, Sague J, Gross C, Henle P et al (2017) Low metallic wear of dynamic intraligamentary stabilization. Tribol Int. 109:217–221

    Article  Google Scholar 

  28. Meister M, Koch J, Amsler F, Arnold MP, Hirschmann MT (2018) ACL suturing using dynamic intraligamentary stabilisation showing good clinical outcome but a high reoperation rate: a retrospective independent study. Knee Surg Sports Traumatol Arthrosc 26:655–659

    Article  PubMed  Google Scholar 

  29. Relph N, Herrington L, Tyson S (2014) The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy 100:187–195

    Article  PubMed  CAS  Google Scholar 

  30. Schliemann B, Glasbrenner J, Rosenbaum D, Lammers K, Herbort M, Domnick C et al (2018) Changes in gait pattern and early functional results after ACL repair are comparable to those of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 26:374–380

    Article  PubMed  Google Scholar 

  31. Schliemann B, Lenschow S, Domnick C, Herbort M, Haberli J, Schulze M et al (2017) Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique. Knee Surg Sports Traumatol Arthrosc 25:1184–1190

    Article  PubMed  Google Scholar 

  32. van Eck CF, Limpisvasti O, ElAttrache NS (2018) Is there a role for internal bracing and repair of the anterior cruciate ligament? a systematic literature review. Am J Sports Med 46:2291–2298

    Article  PubMed  Google Scholar 

  33. Walker D, Hardison R, Schenck R (1994) A baker’s dozen of knee dislocations. Am J Knee Surg 7:117–124

    Google Scholar 

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Funding

The authors received no funding for the conduction of this study.

Author information

Authors and Affiliations

  1. BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany

    Sufian S. Ahmad, Anna J. Schreiner, Steffen Schröter, Stefan Döbele, Marc D. Ahrend, Ulrich Stöckle & Atesch Ateschrang

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Michael T. Hirschmann

  3. University of Basel, Basel, Switzerland

    Michael T. Hirschmann

Authors
  1. Sufian S. Ahmad
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  2. Anna J. Schreiner
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  3. Michael T. Hirschmann
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  4. Steffen Schröter
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  5. Stefan Döbele
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  6. Marc D. Ahrend
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Correspondence to Sufian S. Ahmad.

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Given the type of study, an ethical approval was not necessary for the conduction of this study.

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Ahmad, S.S., Schreiner, A.J., Hirschmann, M.T. et al. Dynamic intraligamentary stabilization for ACL repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 27, 13–20 (2019). https://doi.org/10.1007/s00167-018-5301-z

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  • DOI: https://doi.org/10.1007/s00167-018-5301-z

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