A comparative review on ACL Reconstruction vs Internal brace augmentation






ACLR, Anterior cruciate ligament, Grafts, Knee injury,


Increasing knee injuries mainly of Anterior Crucial Ligament has led to development of different surgical procedures for its treatment. ACL reconstructive surgery is the most frequently used surgery in orthopaedic field. It is performed by either a bone-patellar tendon-bone (BPTB) or semitendinosus and gracilis tendon (STG) graft. Earlier the ACL injury was treated by reconstructing the ligament but recurrence of 2nd injury after surgery was reported. This led to the development of a suture to tie up the graft in its place that provides more knee stability and good functional outcomes. The functional outcome of the surgeries was evaluated by some outcome measures like IKDC, KOOS, Lysholm score etc. The patients who underwent surgery were asked to perform some physical tests to evaluate the success rate of surgery. The results of these tests determined the motion, functional activity, efficacy in sports. This review focuses on understanding the benefits of suture augmentation in combination with ACL reconstruction andalso discusses the combination of these two modalities that has led to a revolutionary change in the future of the ACL ligament surgery.


Download data is not yet available.


Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(1):216-224.

Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42(6):394-412

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part I. The American journal of sports medicine. 2005 Oct;33(10):1579-602.

Ochi M, Iwasa J, Uchio Y, Adachi N, Sumen Y. The regeneration of sensory neurones in the reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 1999 Sep;81(5):902-6.

Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br. 2000 Aug;82(6):801-6.

Lawhorn KW, Howell SM. Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts. Orthop Clin North Am 2003;34:19-30.

Shelton WR, Papendick L, Dukes AD. Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 1997;13:446-449.

McGuire DA, Hendricks SD. Allograft tissue in ACL reconstruction. Sports Med Arthrosc 2009;17:224-233

Barrett GR, Luber K, Replogle WH, Manley JL. Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy 2010;26:1593-1601

Bottoni CR, Smith EL, Shaha J, et al. Autograft versus allograft anterior cruciate ligament reconstruction: A prospective, randomized clinical study with a minimum 10-year follow-up. Am J Sports Med 2015;43:2501-2509

Amis AA, Dawkins GPC: Functional anatomy of the anterior cruciate ligament. J Bone Joint Surgery Br. 1991; 73:260.

Ciccotti MG, Lombardo SJ, Nonweiler B, Pink M. Non-operative treatment of ruptures ofthe anterior cruciate ligamentin middle-aged patients. Results after long-term follow-up. J Bone Joint Surg Am 1994;76:1315–21.

Noyes FR, Matthews DS, Mooar PA, Grood ES. The symptomatic anterior cruciate-deficient knee. Part II: The results of rehabilitation, activity modification, and counseling on functional disability. J Bone Joint Surg Am 1983;65:163–74

Thomee P, Wahrborg P, Borjesson M, Thomee R, Eriksson BI, Karlsson J. Self- ´ efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports TraumatolArthrosc. 2008 Feb;16(2):118-27. Epub 2007 Nov 23

Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011 Mar;39(3):538-43. Epub 2010 Nov 23.

Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011 Jun;45(7):596-606. Epub 2011 Mar 11.

Thomee R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, ´ Werner S, Wondrasch B, Witvrouw E. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports TraumatolArthrosc. 2011 Nov;19(11):1798-805. Epub 2011 Sep 20.

Gilmer BB, Crall T, DeLong J, Kubo T, Mackay G, Jani SS. Biomechanical analysis of internal bracing for treatment of medial knee injuries. Orthopedics 2016;39:532.

Kowalk DL, et al. Anterior cruciate ligament reconstruction and joint dynamics during stair climbing. Med Sci Sports Exerc 1997;29(11):1406–13.

Daniel DM, Malcom LL, Losse GM, Stone ML, Sachs R, Burks RT. Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am. 1985;67:720-726.

Shaw T, Chipchase LS, Williams MT. A users guide to outcome measurement following ACL reconstruction. Physical Therapy in Sport. 2004 May 1;5(2):57-67.

Daniel DM, Malcom LL, Losse GM, Stone ML, Sachs R, Burks RT. Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am. 1985;67:720-726.

Smith, P. A., & Bley, J. A. (2016). Allograft Anterior Cruciate Ligament Reconstruction Utilizing Internal Brace Augmentation. Arthroscopy Techniques, 5(5), e1143–e1147.

Bodendorfer BM, Michaelson EM, Shu HT, Apseloff NA, Spratt JD, Nolton EC, Argintar EH. Suture augmented versus standard anterior cruciate ligament reconstruction: a matched comparative analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Jul 1;35(7):2114-22.

Cook JL, Smith P, Stannard JP, Pfeiffer F, Kuroki K, Bozynski CC, et al. A canine arthroscopic anterior cruciate ligament reconstruction model for study of synthetic augmentation of tendon allografts. J Knee Surg 2017;30: 704-711.

Bachmaier S, Smith PA, Bley J, Wijdicks CA. Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: A biomechanical full construct model. Arthroscopy 2018;34: 490-499.

Smith JO, Yasen SK, Palmer HC, Lord BR, Britton EM, Wilson AJ. Paediatric ACL repair reinforced with temporary internal bracing. Knee Surg Sports TraumatolArthrosc 2016;24:1845-1851.

DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: Early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy 2015;31:2162-2171.

Peterson L, Eklund U, Engström B, Forssblad M, Saartok T, Valentin A. Long-term results of a randomized study on anterior cruciate ligament reconstruction with or without a synthetic degradable augmentation device to support the autograft. Knee Surg Sports TraumatolArthrosc 2013;22:2109-2120.

Additional Files





Original Research Article