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Arthroscopy. 2019 Jul;35(7):2114-2122. doi: 10.1016/j.arthro.2019.01.054. Epub 2019 Jun 2.

Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis.

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Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A.. Electronic address:
Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A.
Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, U.S.A.
Department of Orthopaedic Surgery, Inova Fairfax Hospital, Falls Church, Virginia, U.S.A.



To compare outcomes between standard anterior cruciate ligament reconstruction (ACLR) using hamstring grafts with and without suture augmentation (SA).


Patients who underwent ACLR with hamstring autografts or allografts with minimum 2-year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index, graft type, and revision status to standard ACLR. Range of motion, pain, postoperative activity, patient-reported outcome measures (PROMs), and complications were collected. Paired 2-tailed Student's t-tests and Pearson's χ2-tests were used for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to preinjury activity level was assessed using Spearman's rho and Pearson's χ2-tests.


Sixty patients at a mean age of 29.50 ± 6.60 years, 43.4% male, body mass index 26.27 ± 3.37, and follow-up of 29.54 ± 5.37 months were included. Preoperative PROMs were not significantly different (P >. 05). Postoperative range of motion was similar between groups (P = .457). Postoperative average daily (0.60 ± 1.25 vs 1.66 ± 1.90) and maximum daily pain (1.57 ± 1.83 vs 3.35 ± 2.28) were significantly lower for SA (P < .014). SA predicted improvement in PROMs (P < .05) and maximum pain scores (P = .001). SA was significantly correlated with improved time to return to preinjury activity level (9.17 ± 2.06 vs 12.88 ± 3.94 months; P = .002) and percentage of preinjury activity level (93.33% ± 13.22% vs 83.17% ± 17.69%; P = .010). There was a trend toward improved rate of return to preinjury activity level for SA (76.7% vs 56.7%; P = .100).


Our study demonstrates that SA hamstring ACLRs were associated with improved PROMs, less pain, and a higher percentage of and earlier return to preinjury activity level when compared with standard hamstring ACLRs without evidence of overconstraint.


Level III, retrospective comparative study.

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