Dynamic Intraligamentary Stabilization (DIS) Repair for ACL Ruptures in Pediatric and Adolescent Patients: An Initial Pilot Study with Long-Term Follow Up

TL;DR

A pilot study on 22 children with ACL ruptures found that dynamic intraligamentary stabilization (DIS) had mixed results, with good short-term outcomes but a high failure rate requiring revision surgery.

Contribution

This study is among the first to evaluate DIS for ACL repair in skeletally immature patients and reports long-term follow-up data.

Findings

DIS showed potential for ACL healing with satisfactory short-term functional outcomes in skeletally immature patients.

A 55% failure rate was observed, with reruptures or revision surgeries needed in most patients.

Long-term follow-up showed no significant difference in knee function compared to the uninjured knee three years post-surgery.

Abstract

What are the main findings?
In this pilot series of 22 skeletally immature patients with ACL rupture, dynamic intraligamentary stabilization (DIS) showed potential facilitation of ACL healing with good clinical short term outcomes and satisfactory patient reported outcomes after 11 years.There was a high rate of rerupture and patients needing a revision surgery of 55%.

In this pilot series of 22 skeletally immature patients with ACL rupture, dynamic intraligamentary stabilization (DIS) showed potential facilitation of ACL healing with good clinical short term outcomes and satisfactory patient reported outcomes after 11 years.

There was a high rate of rerupture and patients needing a revision surgery of 55%.

What are the implications of the main finding?
DIS in children carries a substantial risk of failure and should be considered with caution in this population.Preservation of the native ACL is conceptually attractive, but controlled comparative studies are required to define its role in skeletally immature patients.

DIS in children carries a substantial risk of failure and should be considered with caution in this population.

Preservation of the native ACL is conceptually attractive, but controlled comparative studies are required to define its role in skeletally immature patients.

Background/Objectives: The aim of this study was to report first experiences with dynamic intraligamentary stabilization (DIS) technique for anterior cruciate ligament (ACL) rupture in children and adolescents. Methods: A case series of 22 children and adolescents with a mean age of 13.3 years underwent primary repair of an ACL rupture using the DIS technique as an off-label use in skeletally immature patients. Patients were evaluated for laxity, strength, range of motion (ROM), and functional tests, as well as Tegner, Lysholm, International Knee Documentation Committee (IKDC), and PedsQL scores after 3 years. A follow up after 11 years was conducted to analyze long-term results, rerupture rates and reinterventions. Results: Three years after surgery, there was no significant difference in laxity, strength, ROM, and in the functional tests comparing the injured to the contralateral knee. The Tegner Index after surgery showed a slight drop of 0.8 points, from 7.1 preoperatively to 6.3. Mean IKDC, Lysholm, and peds-QL scores were 91.17 (range 62.64–98.85, median 94.25), 88.27 (range 58–100, median 93), and 88.78 (range 58.15–100, median 91.30). Overall failure rate of the DIS-repaired knees was 55% (12 of 22 patients). In ten patients, reruptures happened at an average time of 3.2 years after initial surgery; additionally, two patients with chronic instability had to undergo revision ACL reconstruction. Conclusions: DIS repair might help ACL healing with satisfactory functional outcomes. However, given the high failure and reintervention rates, further studies need to show non-inferiority of the DIS technique in children and adolescents before being considered a valid treatment option.

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