Interference screw-dependent internal bracing for anterior cruciate ligament reconstruction: a comparative study

Background
The internal brace augmentation technique was introduced to protect the graft till the completion of the ligamentization process. This was achieved by adding a synthetic implant to the anterior cruciate ligament (ACL) graft. However, the rarity of reports comparing this principle to the traditional ACL reconstruction represents an obstacle to reaching a consensus about the effectiveness of this technique. Herein, we compared a simple economic modification of the internal brace augmentation technique during the ACL reconstruction with the traditional ACL reconstruction.
Patients and Methods
The study included skeletally mature patients diagnosed with ACL tears who underwent reconstruction surgery between January 2022 and January 2023 (46 patients were included). They were allocated into two groups: the case group, the internal brace group (IB), which included 21 patients, and the control group, the graft only group (GO), which included 25 patients. The patients were followed up for at least 1 year regarding the time of return to the previous level of activity, the International Knee Documentation Committee Subjective Knee Evaluation score at 1 year, the Lachman test, the pivot shift test, and the associated complication rate.
Results
Although both groups scored an excellent International Knee Documentation Committee Subjective Knee Evaluation score (>80), there was a higher statistically significant improvement in the IB group with a mean and SD of 94.8 ± 1.9 compared to the GO group with a mean and SD of 90.6 ± 2.54. Regarding the return to the preinjury activity level, the IB group showed statistically significant earlier return compared with the GO group with a mean and SD of 9 ± 1.6 months compared to 11.8 ± 1.5 months. Furthermore, the IB group showed a statistically significant superior improvement in the anteroposterior knee stability evaluated by the Lachman test.
Conclusion
The interference screw-dependent internal bracing for ACL reconstruction has shown better short-term patient-reported outcome measurements, faster return to preinjury level, and better objective anteroposterior knee stability at 1 year when compared to the traditional technique with adding no extra cost at all.