Repair with suture tape augmentation vs. reconstruction for ACL tears: A systematic review and meta-analysis

Background and aims: Interest in repairing ruptured anterior cruciate ligaments (ACL) has resurged, with suture tape augmentation (internal brace, ACL-IB) emerging as a prominent technique. However, the efficacy of ACL-IB compared to ACL reconstruction (ACL-R) remains unclear. We conducted a meta-analysis to address this gap.

Methods: Adhering to PRISMA guidelines, a search to PubMed, EMBASE and Cochrane Central for studies comparing ACL-IB to ACL-R was performed. The main endpoints were patient-reported outcomes (PROs) and failure rate. Muscle and joint function and surgery time were also assessed. Statistical analysis was performed by Review Manager 5.1.7.

Results: Nine studies comprising 1049 patients were included; 381 (36.3 %) underwent ACL-IB. Hamstring autografts were used for ACL-R in 421 patients (63.0 %). Most studies (6 of 8) reported follow-up longer than two years. The failure rate was higher in the ACL-IB group (risk ratio 3.62; 95 % CI 1.16 to 11.33; p = 0.03; I²: 52 %). No significant difference was found between groups for PROs, except KOOS Symptoms, which was significantly improved with ACL-IB (mean difference 2.49; 95 % CI 0.05 to 4.92; p = 0.05; I²: 0 %). ACL-IB resulted in stronger hamstrings (mean difference 11.99 %; 95 % CI 4.47 %-19.51 %; p = 0.002; I²: 73 %). No significant difference was found in anterior tibial translation and quadriceps strength.

Conclusions: ACL-IB had a higher failure rate compared to ACL-R. However, ACL-IB showed better hamstring strength and KOOS symptom score. No significant differences were seen in other PROs, time to return to sports, or quadriceps strength.