The effect of short-graft preparation with tape suspension and screw fixation on loss of knee extension following anterior cruciate ligament reconstruction: A retrospective cross-sectional analysis of public hospital cases from 2015 - 2017

IntroductionThe short graft with tape suspension (SGTS) is a technique for ACL reconstruction that has gained popularity in recent years. Though the construct utilises a hamstring tendon, its biomechanical properties more closely resemble a stiffer graft such as bone-patella-bone. Due to these properties, there are concerns this technique may increase the likelihood of postoperative loss of extension (LOE), particularly if the surgeon does not modify their tensioning technique. This study compared LOE in patients undergoing ACLR with the SGTS technique, versus other ACLR techniques. We hypothesised that with appropriate technique modifications, the SGTS technique would not be inferior to long hamstring graft techniques with respect to LOE observed clinically during supervised rehabilitation. Materials and MethodsWe retrospectively reviewed 138 patients who received primary ACLR at one of two hospitals between January 2015 and December 2017 and elected to participate in a rehabilitation program with the hospital physiotherapy department. Postoperative knee extension was assessed by a department physiotherapist until satisfactory function was achieved. Patients were classified as SGTS ACLR or non-SGTS ACLR during chart review and LOE compared at initial assessment and at the time of maximum extension, via a noninferiority analysis. ResultsThe grafts for the SGTS group (N=44) were significantly larger in diameter (median 8.5mm vs. 8.0mm, P <0.001) and less incidence of notchplasties (17.8% vs. 44.7%, P <0.001) compared with the non-SGTS group (N=94). The upper 95% confidence interval for the difference in proportions between groups did not exceed the non-inferiority margin (0.3 or 30%) at either Initial or Maximum timepoints. ConclusionsThe SGTS technique was not inferior to other hamstring-graft ACLR techniques with respect to postoperative LOE. Surgeons using or considering using the SGTS construct can rule out increased incidence of LOE as a factor in their decision-making, providing the grafts are prepared according to existing guidance and tensioned in full extension. Further studies are recommended to assess longer term functional outcomes and ultimately treatment success.