AJSM - 2026-08-11 - Journal Article
Outcomes of Suture Tape-Augmented ACL Reconstruction in Patients With High Internal Rotational Tibial Subluxation: A Minimum 3-Year Cohort Study.
Wang Y, Zhang Y, Shi W, Wang J, Wang H, Liu Y, Yuan F, Ao Y, Dai W, Gong X
Topics
Key Takeaway
Suture tape augmentation of hamstring autograft ACLR in patients with high internal rotational tibial subluxation (>5.8 mm) reduced graft failure to 0% versus 12.9% in matched controls at mean 3.8-year follow-up.
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Summary
This retrospective cohort study asked whether suture tape augmentation (STA) of hamstring autograft ACLR reduces graft failure and improves outcomes in patients with high internal rotational tibial subluxation (IRTS >5.8 mm lateral minus medial anterior tibial subluxation). Propensity score-matched patients with high IRTS underwent ACLR with or without STA and were assessed at minimum 3 years using IKDC, Lysholm, Tegner, return-to-sport, and graft failure rates. The STA group achieved 0% graft failure versus 12.9% in controls (P=.039), a return-to-sport rate of 74.2% versus 48.4% (P=.037), and significantly higher rates of MCID, PASS, and SCB achievement across all PRO instruments.
Key Limitation
The sample size of 31 per group is underpowered to detect differences in low-frequency events such as graft failure, and the 0% failure rate in the STA group may reflect type II error or short follow-up rather than true superiority.
Original Abstract
BACKGROUND
Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts faces persistent challenges of graft failure, especially in patients with high internal rotational tibial subluxation (IRTS).
HYPOTHESIS
Patients with high IRTS who undergo HT autograft ACLR with suture tape augmentation (STA) will have lower graft failure rates and superior clinical outcomes as compared with those without STA.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
This retrospective cohort study included patients with high IRTS-defined as lateral minus medial anterior tibial subluxation >5.8 mm based on prior studies-who underwent primary ACLR using HT autografts with STA and had a minimum follow-up of 3 years. Propensity score matching (1:1) was performed to identify a control group of patients with similarly high IRTS who underwent HT ACLR without STA. Postoperative outcomes were assessed by the International Knee Documentation Committee score, Lysholm score, and Tegner activity scale, as well as by return-to-sport status and graft failure. Clinically meaningful improvements were evaluated by the minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit.
RESULTS
This study included 62 patients with high
IRTS
31 with STA and 31 matched controls. The mean IRTS was 6.6 mm (range, 5.9-8.9) in the STA group and 6.8 mm (range, 5.8-8.7) in the control group. The mean patient age was 32.9 years (range, 20-50), and the mean follow-up was 3.8 years (range, 3.1-5.0). At final follow-up, the STA group showed significantly higher proportions of patients achieving the minimal clinically important difference (93.5% vs 74.2%; P = .038), Patient Acceptable Symptom State (96.8% vs 74.2%; P = .012), and substantial clinical benefit (54.8% vs 25.8%; P = .020). The return-to-sport rate was also higher in the STA group (74.2% vs 48.4%; P = .037). Additionally, the STA group demonstrated a lower graft failure rate (0% vs 12.9%; P = .039).
CONCLUSION
For patients with high IRTS, STA in ACLR with HT autografts is associated with improved clinical outcomes, a higher return-to-sport rate, and a lower risk of graft failure at midterm follow-up.