Anterior Cruciate Ligament Reconstruction With Hamstring Autografts and Suture Tape Augmentation Results in Lower Failure Rates While Maintaining Functional Outcomes and Complication Rates Similar to Nonaugmented Techniques: A Systematic Review and Meta-analysis

Background: Anterior cruciate ligament reconstruction with suture augmentation (ACLR-SA) has been explored for its potential to provide additional graft protection. Purpose: To compare failure rates, complications, patient-reported outcomes, and return to sport between ACLR-SA and nonaugmented ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 2. Methods: Randomized controlled trials and quasi-experimental studies were included if they provided data on population (patients with anterior cruciate ligament tear), intervention (ACLR-SA regardless of SA material and graft type), comparator (nonaugmented ACLR), and outcomes (failure, arthrofibrosis and cyclops, subsequent meniscal surgery, hardware removal, Lysholm and International Knee Documentation Committee scores, and/or return to sport). Results: Eleven articles (1179 patients) were included. ACLR performed with hamstring autograft augmented with FiberTape reduced failure rates as compared with nonaugmented ACLR (3.1% vs 8.5%; odds ratio [OR], 2.86; 95% CI, 1.03-7.90; P = .043; I 2 = 0%). In addition, the 2 techniques showed no differences in arthrofibrosis/cyclops (OR, 0.94; 95% CI, 0.26-3.33; P = .919; I 2 = 0%), subsequent meniscal surgery (OR, 1.05; 95% CI, 0.32-3.44; P = .942; I 2 = 0%), International Knee Documentation Committee score (mean difference, –1.20; 95% CI, –3.06 to 0.06; P = .206; I 2 = 0%), and Lysholm score (mean difference, –0.96; 95% CI, –4.53 to 2.61; P = .597; I 2 = 65%). When the FiberWire was utilized for hamstring autograft suture augmentation, no significant differences in failure rates were observed between groups. The pooled synthesis for all graft and augmentation combinations showed that ACLR-SA was associated with an increased return to preinjury activity level (72.5% vs 54.0%; OR, 0.44; 95% CI, 0.21-0.91; P = .027; I 2 = 0%). Conclusion: Available evidence supports the use of suture tape augmentation in ACLRs performed with hamstring autografts, as it reduces failure rates while maintaining equivalent complication rates and patient-reported outcomes as compared with nonaugmented ACLR.