AUGMENTATION OF CRUCIATE LIGAMENT SURGERY - IS IT OUT

Basics of ligament augmentation are reviewed from the literature. As b iomechanical in-vitro studies, animal experiments, and clinical studie s show different designs and data, the results may be interpreted vari ably. Theoretically there is a positive effect of augmentation, but no significant improvement of clinical results is evident. The goal of o ur own prospective study was to check the healing capacity of a repair ed and augmented ACL with respect to stability compared to a primary o r secondary BTB ligament replacement with and without augmentation. 20 0 patients were allocated to 4 groups. In group I (G1) acute proximal ruptures were repaired arthroscopically and augmented with PDS II-cord . Patients in G2 received an acute and in G3 a late BTB ligament repla cement. Additionally in G4 a late ligament replacement was augmented w ith a PDS II-cord. The clinical results reveal a comparative stability between G1 and G2, and gradually less stability in G3 and G4. Subject ively, knee function was felt best in G1 and G2 while beeing worst in G3 and G4. There is no significant difference in the mobility of knees between primary and secondary ligament replacement. An additional aug mentation doesn't improve the knee stability. Clinical relevance: Ther e is no positive effect of an augmentation technique of a biologic lig ament replacement concerning stability, morbidity, complication rate, and costs. Very marginal freshly ruptured cruciate ligaments may be re inserted successfully by a biodegradable augmentation. Subjective feel ing and functional stability may be at least equal to a primary ligame nt replacement. There are no advantages in knee mobility, when a secon dary ligament replacement is performed.