Does combined ACL primary augmentation with autograft reconstruction reduces risk of failure at 3-years follow-up compared to ACL reconstruction?

PURPOSE: Re-rupture after anterior cruciate ligament (ACL) repair is frequent, raising the question of graft integration failure. However, the introduction of new materials and techniques has brought ACL repair back into fashion, especially ACL augmentation using the hamstrings. Purpose To evaluate ACL augmentation, using a hamstring graft, complete remnant conservation and its fixation to the femur, and to compare it with "conventional" ACL reconstruction with a semi-tendinosus graft without anterolateral ligament reconstruction. The re-rupture rate, re-intervention rate, intraoperative data (tunnel size, meniscal lesions, tourniquet time), and post-operative subjective scores (SKV, IKDC, ACL-RSI) at 3 years follow-up were compared for the two techniques. METHODS: ACL augmentation was performed in 60 consecutive patients, 47 of whom were evaluated (ACL-A group) (seven excluded for re-rupture and six lost to follow-up). This group was compared with a control group of 63 patients who had undergone "conventional" ACL reconstruction (ACL-R group) with a semi-tendinosus graft without anterolateral ligament reconstruction (three patients were excluded due to re-rupture). Both groups were comparable for sex, age, body mass index, surgical delay, tunnel size and meniscal lesion rate. RESULTS: There was no significant difference between the two groups for clinical outcomes at 3 years follow-up: median scores for ACL-RSI (ACL-A: 75 vs. ACL-R: 72; p = 0.27), IKDC (ACL-A: 90 vs. ACL-R: 86; p = 0.20), Tegner (ACL-A: 7.0 vs. ACL-R: 6.0; p = 0.19) or SKV (ACL-A: 90 vs. ACL-R: 90; p = 0.58). Graft failure rate was also similar at 3 years follow-up (ACL-A: 13.0% vs. ACL-R: 4.8%; p = 0.18), so was complication rate (ACL-A: 16.7% vs. ACL-R: 11.1%; p = 0.44). The ACL-A group had a significantly longer median tourniquet time (42 min) compared to the ACL-R group (35 min) (p < 0.0001). CONCLUSION: ACL augmentation did not improve clinical results, complication rates, or graft failure rate at 3 years post-surgery, despite a longer surgery time and more challenging technique. LEVEL OF EVIDENCE: Level II.