No evidence of reduced autograft ACL rupture rates with synthetic reinforcement: A systematic review

Importance Synthetic reinforcement of autografts in anterior cruciate ligament reconstruction offers theoretical benefits in terms of improved graft strength, potentially reducing graft elongation and failure. Over the past three decades, a number of synthetic/autograft combinations have been used in clinical practice. Aim We aimed to assess the impact of synthetic reinforcement on graft rupture rates and functional outcomes following autograft ACL reconstruction. Evidence review A systematic review of Pubmed, Embase and Cochrane libraries was undertaken according to the PRISMA guidelines. Published clinical studies reporting outcomes after autograft ACL reconstruction with synthetic reinforcement, with a minimum of 20 patients and two-year follow-up were included. The MINORS tool was used for methodological assessment. Findings Twenty articles reporting 1888 patients managed with synthetically reinforced grafts were included in the analysis. The mean MINORS score was 13 (Range, 2–22). The synthetic reinforcement used was the Kennedy ligament augmentation device in eight studies, LARS in four, Fibretape in two, Leeds-Keio in two, and Trevira ligament, Dacron, PDS and Artelon in one study each. No study reported a significant reduction in graft failure with reinforcement. Two studies reported superior KT-1000 clinical stability in reinforced grafts. One study reported superior pain, KOOS and IKDC scores and earlier return to activity in reinforced grafts. Conclusions and relevance In this systematic review, synthetic reinforcement of ACL autografts did not result in a reduced rate of graft rupture. A small number of studies have reported superior stability and patient-reported outcome measures with modern synthetic reinforcement techniques. Level of evidence 4