Arthroscopic ACL repair with suture tape augmentation: clinical, functional, and gait analysis outcomes at minimum 3-year follow-up

Introduction: Recent advancements in surgical techniques have led to renewed interest in ACL repair, particularly for acute, proximal tears. Suture tape augmentation (STA) has emerged as a promising technique to support ACL healing while preserving native tissue and potentially improving outcomes. This study aims to evaluate the outcomes of ACL repair with STA in patients with acute, proximal ACL tears.

Methods: We retrospectively reviewed patients who underwent ACL repair with STA between June 2018 and October 2020. Inclusion criteria were acute (< 6 weeks) ACL rupture, Sherman type I tears, and minimum follow-up of 3 years. Exclusion criteria included mid-substance or distal ACL tears and previous knee surgeries. Clinical evaluation involved stability tests, PROMs, and gait analysis using Prokin WalkerView. Second-look arthroscopy and histological analysis were conducted on a subset of patients.

Results: Twelve consecutive patients (7 males and 5 females) with a mean age of 27.4 ± 7.9 years and mean BMI of 23.3 ± 1.6 kg/m² were included. Time to operation was 19.5 ± 8.7 days. Mean follow-up duration was 53.2 ± 9.4 months. One patient experienced a traumatic re-rupture. One had a contralateral ACL tear and one experienced hardware irritation. Clinical tests were negative for instability in all patients. Post-operative IKDC, Lysholm, and FJS-12 scores showed significant improvement (p < 0.001). All patients (100%) achieved minimal clinically important difference for all PROMs. Walking gait analysis revealed high symmetry indices for range of motion (93.50%) and step length (95.80%) with near symmetrical loading. Second-look arthroscopy showed intact repairs with healthy tissue morphology and integration. Histology revealed increased cellularity, high nuclear density, and preservation of vascular and neural components indicated by CD34 and S-100 markers.

Conclusions: Arthroscopic ACL repair with STA provides favourable clinical, functional, and histological outcomes with low re-rupture rates when performed on acute, proximal ACL tears. This technique demonstrates fair-to-good PROMs, functional stability, and near-normal gait parameters.