Summary
A matched cohort study to assess the effect on healing of adding an internal brace to hamstring autograft ACLR as measured via MRI graft signal at 12 months.
Abstract
Background
The Internal brace has been proposed as an adjunct to biological ACLR. While time zero biomechanical data is encouraging there is a paucity of clinical data about its outcomes on graft healing or clinical effects.
Objective
To determine the influence of an internal brace on the healing of a primary single bundle ACL graft.
Methods
A case series of 70 patients who had a single bundle ACL reconstruction by two surgeons using hamstring autograft with bicortical suspensory fixation and addition of a FiberTape Internal Brace were compared to an age and sex matched cohort of patients with the same technique but no internal brace (matched cohort study). Graft healing was assessed at 12 months via standardised MRI scans using a previously published protocol analysing graft signal/noise quotient (SNQ) across three sites of the graft. Patient reported outcomes (PROMS) with IKDC, Tegner and Lysholm scores were also recorded, and stability assessed via KT-1000.
Results
At 12 months there was no reruptures in either group and no difference between groups for IKDC, Tegner, Lysholm, or stability (KT-1000).
SNQ measurements showed a significant difference between the IB and no-IB groups at proximal, midsubstance, distal regions of interest (ROI), and overall average signal (SNQ 3.6 ± 3.7 Vs 2.3 +/- 1.5, 5.7 ± 5.1 Vs 3.26 +/- 2.1, 2.6 ± 3.4 Vs 1.7 +/- 1.7, 4.0 ± 3.4 Vs 2.4 +/- 1.4 respectively).
There was no differences between males and females in either group.
Conclusion
The use of an internal brace in a single-bundle hamstring ACL reconstruction using hamstring autograft and bicortical suspensory fixation shows equivalent clinical results at 1 year compared to a matched cohort without internal brace. MRI assessment shows higher signal in the graft tissue of the internal brace group at 3 ROI along the graft, and overall, raising the possibility of less complete healing or graft quality at 1 year in the internal brace group.