Physeal-sparing anterior cruciate ligament reconstruction in an early adolescent porcine model provides better anterior stability but similar tissue function compared to a juvenile porcine model.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest All authors declare that they have no financial and personal relationships with other people or organizations that could inappropriately influence their work. 12. BMC Musculoskelet Disord. 2019 Nov 18;20(1):547. doi: 10.1186/s12891-019-2926-0. Study protocol: a single-blind, multi-center, randomized controlled trial comparing dynamic intraligamentary stabilization, internal brace ligament augmentation and reconstruction in individuals with an acute anterior cruciate ligament rupture: LIBRƎ study. Heusdens CHW(1), Zazulia K(2), Roelant E(3), Dossche L(2), van Tiggelen D(4), Roeykens J(5), Smits E(6), Vanlauwe J(7), Van Dyck P(8). Author information: (1)Department of Orthopaedics, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. Krik.Heusdens@uza.be. (2)Department of Orthopaedics, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. (3)Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium. (4)Department of Traumatology and Rehabilitation, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Neder-Over-Heembeek, Belgium. (5)Department of Rehabilitation, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. (6)Department of Medical management, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. (7)Department of Orthopaedics and Traumatology, University Hospital Brussels, Laarbeeklaan 101, 1090, Jette, Belgium. (8)Department of Radiology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. BACKGROUND: The current gold standard for the treatment of an anterior cruciate ligament (ACL) rupture is reconstruction with tendon graft. Recently, two surgical ACL repair techniques have been developed for treating an acute ACL rupture: Dynamic Intraligamentary Stabilization (DIS, Ligamys®) and Internal Brace Ligament Augmentation (IBLA, InternalBrace™). We will conduct a single-blind, multi-center, randomized controlled trial which compares DIS, IBLA and reconstruction for relative clinical efficacy and economic benefit. METHODS: Subjects, aged 18-50 years, with a proximal, primary and repairable ACL rupture will be included. DIS is preferably performed within 4 weeks post-rupture, IBLA within 12 weeks and reconstruction after 4 weeks post-rupture. Patients are included in study 1 if they present within 0-4 weeks post-rupture and surgery is feasible within 4 weeks post-rupture. Patients of study 1 will be randomized to either DIS or IBLA. Patients are included in study 2 if they present after 4 weeks post-rupture and surgery is feasible between 5 and 12 weeks post-rupture. Patients of study 2 will be randomized to either IBLA or reconstruction. A total of 96 patients will be included, with 48 patients per study and 24 patients per study arm. Patients will be followed-up for 2 years. The primary outcome is change from baseline (pre-rupture) in International Knee Documentation Committee score to 6 months post-operatively. The main secondary outcomes are the EQ-5D-5 L, Tegner score, Lysholm score, Lachman test, isokinetic and proprioceptive measurements, magnetic resonance imaging outcome, return to work and sports, and re-rupture/failure rates. The statistical analysis will be based on the intention-to-treat principle. The economic impact of the surgery techniques will be evaluated by the cost-utility analysis. The LIBRƎ study is to be conducted between 2018 and 2022. DISCUSSION: This LIBRƎ study protocol is the first study to compare DIS, IBLA and ACL reconstruction for relative clinical efficacy and economic benefit. The outcomes of this study will provide data which could aid orthopaedic surgeons to choose between the different treatment options for the surgical treatment of an acute ACL rupture. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov; NCT03441295. Date registered 13.02.2018. DOI: 10.1186/s12891-019-2926-0 PMCID: PMC6862787