Addressing High-Grade Pivot Shift: Clinical Outcomes of Internal Brace-Augmented Anterior Cruciate Ligament (ACL) Reconstruction

Background and objective Anterior cruciate ligament (ACL) injuries associated with high-grade pivot shift represent a challenging subset of rotational knee instability. Internal brace augmentation using FiberTape (Arthrex, Inc., Naples, FL, USA) has been proposed to enhance graft protection during early healing and rehabilitation following ACL reconstruction. The objective of this study was to evaluate the functional and clinical outcomes of arthroscopic ACL reconstruction with internal brace augmentation in patients presenting with Grade III preoperative pivot shift. Methods A prospective cohort study was conducted at a tertiary care center involving patients with complete ACL tears and Grade III pivot shift who underwent arthroscopic ACL reconstruction with hamstring autograft and FiberTape augmentation. Patients with multiligament injuries, revision surgery, generalized laxity, or significant meniscal injuries requiring extensive intervention were excluded. Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score, and International Knee Documentation Committee (IKDC) score at predefined follow-up intervals up to 12 months. Clinical stability was evaluated using Lachman and pivot shift tests. Results A total of 43 patients completed the study. Progressive and statistically significant improvement was observed across all KOOS domains, Lysholm scores, and IKDC scores throughout follow-up. By 12 months, most patients achieved excellent functional outcomes, with marked improvement in sports activity and quality-of-life measures. Clinical examination demonstrated restoration of rotational stability in the majority of patients, with most achieving Grade 0 pivot shift and Lachman test results at final follow-up. No patient demonstrated high-grade residual laxity during the study period. Conclusions Arthroscopic ACL reconstruction with internal brace augmentation demonstrated excellent functional recovery and restoration of rotational stability in patients with Grade III pivot shift. The technique appears to be a valuable adjunct in managing severe rotational instability, with favorable short-term clinical outcomes and stable knee function during follow-up.