Podium (Sports) 15

Bridge-Enhanced Anterior Cruciate Ligament Repair versus Anterior Cruciate Ligament Reconstruction: A meta-analysis of Initial Randomized Controlled trials

Gian Domini M. Punsalan, MD

Introduction: Historically, anterior cruciate ligament repair was abandoned due to poor functional outcomes, high revision rates, prolonged instability, and low rates of return to activities, as well as comparative research demonstrating improved results with ACL reconstruction. Currently, hamstring autografts or bone-patellar tendon bone autografts (BPTB) are the "gold standard" techniques for repair in younger populations. However, preclinical studies in animal models have shown that a scaffold implant could be positioned in the joint to bridge the gap of a mid-substance ACL tear and facilitate healing. The current technique for bridge-enhanced ACL repair (BEAR) involves placing a resorbable protein-based implant containing autologous blood in the gap between the 2 torn ends of a mid-substance ACL tear in combination with suture repair of the ligament and a suture cinch to reduce the tibiofemoral joint. Early randomized clinical trials are now done to assess if a bridge-enhanced anterior cruciate ligament repair would be a viable alternative to an Anterior Cruciate Ligament Reconstruction.


Methodology: This meta-analysis included comparative clinical trials randomized or parallel or cross-over clinical trial design involving humans as the clinical subjects. The researcher included published studies in peer reviewed journals of PubMed, clinical trials registered Cochrane Central Register of Controlled Trials and the grey literature. Medline / PubMed, Embase, CINAHL, Cochrane Database of Controlled Trials (CENTRAL), LILACS, SciELO, clinicaltrials.gov, WHO ICTRP and Google Scholar were used to search for randomized clinical trials.. The researcher employed the Highly Sensitive Analysis Method of the Cochrane Collaboration to maximize performance.


Results: 3 randomized controlled trials were finally included after qualitative and quantitative synthesis. A total population size of 229 was included across the 3 studies. Revman 5 (Review Manager 5) was utilized to compare the primary outcomes related to the included studies. All studies evaluated mean IKDC score in 148 patients treated with BEAR and 81 patients treated with ACL reconstruction. No significant difference was found in the mean IKDC score between the 2 groups. (mean difference between BEAR and ACLR groups, 1.96; 95% CI, -1.41, 5.33; P = .26) (Figure 3).

All studies evaluated mean AP knee laxity in 148 patients treated with BEAR and 81 patients treated with ACL reconstruction. No significant difference was found in the mean AP knee laxity between the 2 groups. (mean difference between BEAR and ACLR groups, -0.13; 95% CI, -0.97, 0.71; P = .76) (Figure 1)


Conclusion: Currently, the literature available suggests that Bridge-Enhanced ACL repair could be a viable option versus performing an Anterior Cruciate Ligament Reconstruction. However, there are limitations to this study. Currently, there are only a handful of studies regarding Bridge-Enhanced Anterior Cruciate Ligament Repair as this was just recently approved by the FDA last 2020. Currently, there are now ongoing studies with large sample sizes comparing BEAR to ACL reconstruction. Further trials and long-term studies may be needed to assess the outcome of BEAR regarding, repair failure long-term, return to physical activity and infection rate. The researcher plans to add these studies to the meta-analysis and do a subgroup analysis once they are published.