Anterior Cruciate Ligament Repair with Internal Brace Ligament Augmentation
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Abstract: Background: Anterior cruciate ligament (ACL) reconstruction using tendon or ligament autograft is the gold standard surgical treatment for acute ruptures; however, this is still associated with subsequent problems and variable outcomes. Renewed interest in healing of injured ACL tissue has led to new surgical repair techniques. Case Description: We report the case of one of the first patients to undergo this novel procedure of ACL repair with internal bracing. An internal brace is a bridging concept using braided suture tape and knotless bone anchors to reinforce ligament strength. We followed the case of one of the first patients to undergo this technique over two years post-operatively. Outcomes: In this case, we present a good functional outcome along with radiographic and arthroscopic evidence of a healed ACL with normal appearance. The successful application of this technique has been demonstrated. Discussion: ACL repair techniques are re-emerging as a promising treatment option for acute proximal ruptures. Repair of the ACL can be performed successfully and has the advantage of retaining the natural proprioceptive fibres of the ligament. The internal brace acts as a secondary stabiliser after repair, which may allow accelerated rehabilitation and return to sports, whilst resisting injury recurrence when this is possible. Conclusions: Repair with internal bracing of the ACL provides an unobtrusive support which allows accelerated recovery. In this case, we demonstrate with radiographic and arthroscopic evidence, a robustly healed ACL after repair with internal bracing. Functional outcomes are excellent over two years following surgery and long term; retained proprioception may prevent re-injury and development of post-traumatic osteoarthritis. Authors: William T. Wilson, MBChB, Specialty Registrar, Trauma and Orthopaedics Department, Queen Elizabeth University Hospital, Glasgow, United Kingdom, Graeme P. Hopper, MBChB, Specialty Registrar, Trauma and Orthopaedics Department, Queen Elizabeth University Hospital, Glasgow, United Kingdom, Paul A. Byrne, MBChB, Foundation Doctor, Edinburgh Royal Infirmary, Edinburgh, United Kingdom, Gordon M. MacKay, MD, Consultant Orthopaedic Surgeon, Rosshall Hospital, Glasgow, United Kingdom |
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