Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work

Kathrin S Bieri; Stefan M Scholz; Sandro Kohl; Emin Aghayev; Lukas P Staub

doi:10.1016/j.injury.2017.03.004

Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work

Injury. 2017 Jun;48(6):1243-1248. doi: 10.1016/j.injury.2017.03.004. Epub 2017 Mar 7.

Authors

Kathrin S Bieri¹, Stefan M Scholz², Sandro Kohl³, Emin Aghayev⁴, Lukas P Staub⁴

Affiliations

¹ Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland. Electronic address: kathrin.bieri@ispm.unibe.ch.
² Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland.
³ Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
⁴ Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Switzerland.

PMID: 28318538
DOI: 10.1016/j.injury.2017.03.004

Abstract

Purpose: The dynamic intraligamentary stabilization (DIS) technique is based on a different treatment approach than ACL reconstruction in that it intends to promote self-healing of the ligament. It is only recommended for acute injuries (<21days). The purpose of the present study was to compare DIS and ACLR with respect to the extent of work incapacity, revision rates, secondary arthroscopies, and treatment costs during recovery.

Methods: The study was a post-hoc analysis of prospectively collected data in the Swiss National Accident Insurance Fund (SUVA) database. All registered DIS cases treated until 31 December 2012 were included in the study. ACLR cases were matched to DIS cases using a propensity score approach and analysed in a follow-up period of 2 years after injury. Paired Student's T-test and the Chi-square test were used to compare the outcome measures.

Results: All 53 DIS patients were matched to an ACLR pair. The mean time period from injury to surgery was 14days for DIS and 50days for ACLR (p<0.001). Overall work incapacity was 13% for DIS and 17% for ACLR resulting in a difference of nearly 1 month of absence from work (p=0.03). The course of postoperative work incapacity was very similar between the groups, while the work incapacity prior to surgery lower in the DIS group. We found no difference in treatment costs, secondary arthroscopies and revision rates.

Conclusion: DIS patients benefited from nearly one month shorter absence from work than ACLR patients. This difference is likely related to the early surgical timing that is recommended for DIS. Since no differences were found between DIS and ACLR in terms of treatment costs, secondary arthroscopies and revision rates, the study supports the choice of DIS as an additional treatment option for acute ACL injuries. Further comparative studies are proposed to improve the evidence about optimal timing and best practice in ACL treatment.

Keywords: ACL repair; ACL surgery timing; Anterior cruciate ligament; Dynamic intraligamentary stabilization; Ligamys; Return to work; Work capacity.

Publication types

Comparative Study

MeSH terms

Adult
Anterior Cruciate Ligament Injuries / physiopathology
Anterior Cruciate Ligament Injuries / rehabilitation
Anterior Cruciate Ligament Injuries / surgery*
Anterior Cruciate Ligament Reconstruction* / instrumentation
Biomechanical Phenomena
Case-Control Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Patient Satisfaction / statistics & numerical data
Prospective Studies
Recovery of Function
Return to Work* / economics
Return to Work* / statistics & numerical data
Sick Leave / economics
Sick Leave / statistics & numerical data
Suture Techniques
Treatment Outcome
Young Adult