COMPARISON OF OUTCOMES OF ANTERIOR CRUCIATE LIGAMENT RECONCSTRUCTION WITH VERSUS WITHOUT INTERNAL BRACE
DOI:
https://doi.org/10.71000/gz05rg63Keywords:
Anterior Cruciate Ligament, Arthroscopy, Autograft, , Internal Brace, Knee Injuries, Ligament Reconstruction, , Lysholm Score, Orthopedic Surgery, Rehabilitation, , Tendon GraftingAbstract
Background: Anterior cruciate ligament (ACL) tears are common orthopedic injuries that significantly impair knee function. Although arthroscopic ACL reconstruction is the gold standard treatment, residual rotational instability remains a concern. Recently, internal brace (IB) augmentation has been introduced to enhance mechanical support and improve functional recovery.
Objective: To evaluate the functional outcomes of ACL reconstruction with and without internal brace augmentation using the Lysholm knee score at 12 weeks postoperatively.
Methods: This descriptive study was conducted over six months at the Department of Orthopedics, Khyber Teaching Hospital, Peshawar. A total of 72 patients aged 18–60 years with clinically diagnosed ACL tears were enrolled using non-probability consecutive sampling. Patients were divided into two equal groups: one underwent ACL reconstruction with internal brace augmentation and the other without. All surgeries were performed by a single arthroscopic surgeon using hamstring tendon autografts. Functional outcomes were assessed using the Lysholm score at 12 weeks postoperatively. Data were analyzed using SPSS version 25, with statistical significance set at p ≤ 0.05.
Results: Patients in the internal brace group showed significantly higher Lysholm scores (mean ± SD: 86.4 ± 5.2) compared to those without internal bracing (79.2 ± 6.3) (p < 0.05). A greater proportion of patients in the brace group achieved good to excellent outcomes (77.8%) compared to the non-brace group (55.6%). Stratified analysis confirmed consistent trends across age, gender, BMI, and laterality.
Conclusion: ACL reconstruction with internal brace augmentation results in superior early functional outcomes compared to conventional reconstruction. Internal bracing may serve as an effective adjunct for enhancing postoperative recovery and knee stability.
References
Lin W, Chen X, Li D, He W, Lyu J. Anatomical features and tibial tunnel placement: influence on graft maturity at a 2-year follow-up after anterior cruciate ligament reconstruction. Acta Radiol. 2025;66(8):902-7.
Nguyen T, Haider S, Tietze D, Xi Y, Thakur U, Shah J, et al. Anterior cruciate ligament foot plate anatomy: 3-dimensional and 2-dimensional MRI evaluation with arthroscopy assessment in a subset of patients. Eur Radiol. 2022;32(12):8386-93.
Zhang Y, Wang X, Li J, Huang X. [Arthroscopic reinforced reconstruction of anterior cruciate ligament with autologous hamstring tendon and anchor suture band]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021;35(2):171-7.
Thilak J, Panicker J. Arthroscopic remnant preservation anterior cruciate ligament reconstruction using quadrupled semitendinosus autograft with internal brace: A current technique. J isakos. 2025;13:100918.
Minamoto Y, Akagi R, Maki S, Shiko Y, Tozawa R, Kimura S, et al. Automated detection of anterior cruciate ligament tears using a deep convolutional neural network. BMC Musculoskelet Disord. 2022;23(1):577.
Vijayan S, Kyalakond H, Kulkarni MS, Aroor MN, Shetty S, Bhat V, et al. Clinical outcome of anterior cruciate ligament reconstruction with modified transtibial and anteromedial portal. Musculoskelet Surg. 2023;107(1):37-45.
Wang F, Wang G, Li Y, Li H, Shi Q, Li L. [Comparative study of I.D.E.A.L. technique and transtibial technique in anterior cruciate ligament reconstruction]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024;38(8):987-94.
Xu LH, Jin JX, Liu ZC, Jiang J, Wang H, Xia YY, et al. [Comparative study on posterior cruciate ligament reconstruction with autologous hamstring tendon and LARS artificial ligament in the treatment of KD-Ⅲ-M knee dislocation]. Zhongguo Gu Shang. 2021;34(12):1103-7.
Tran A, Lassalle L, Zille P, Guillin R, Pluot E, Adam C, et al. Deep learning to detect anterior cruciate ligament tear on knee MRI: multi-continental external validation. Eur Radiol. 2022;32(12):8394-403.
Yu H, Dong Z, Shi Z, Li L, Dong K, Liu H, et al. [Early effectiveness of local injection of multimodal drug cocktail during anterior cruciate ligament reconstruction and its influence on cartilage]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024;38(5):562-9.
Saithna A. Editorial Commentary: Preferred Strategies to Avoid Collision Between Tunnels for Lateral Extra-articular Procedures and Anterior Cruciate Ligament Reconstruction Include Outside-In Drilling, Cortical Fixation, and Use of a Single Femoral Tunnel. Arthroscopy. 2025;41(6):1957-60.
Dai J, Li Y. Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy. Comput Math Methods Med. 2022;2022:2915157.
Taylor MZ, Caldwell PE, 3rd, Pearson SE. Failure and Complication Rates in Common Sports and Arthroscopic Procedures: Reality Check. Sports Med Arthrosc Rev. 2022;30(1):10-6.
Vascellari A, Grassi A, Canata GL, Zaffagnini S, Gokeler A, Jones H. Hamstrings substitution via anteromedial portal with optional anterolateral ligament reconstruction is the preferred surgical technique for anterior cruciate ligament reconstruction: a survey among ESSKA members. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1120-7.
Zhang ZY, Hong LJ, Bai WB, Shao JY, Gao YT, Fu XY, et al. Increased global posterior tibial slope is significantly associated with higher ACL graft signal intensity on 2-Year postoperative MRI after primary ACL reconstruction using hamstring tendon autografts. BMC Musculoskelet Disord. 2024;25(1):905.
Koukoulias NE, Germanou E, Koukoulias D, Vasiliadis AV, Dimitriadis T. Intra-articular migration of tibial suture button in pediatric full epiphyseal anterior cruciate ligament reconstruction. A case report. J isakos. 2024;9(5):100303.
Abibe RB, Rahal SC, Dos Reis Mesquita L, Doiche D, da Silva JP, Mamprim MJ, et al. Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits. PeerJ. 2023;11:e14777.
Stone AV, Marx S, Conley CW. Management of Partial Tears of the Anterior Cruciate Ligament: A Review of the Anatomy, Diagnosis, and Treatment. J Am Acad Orthop Surg. 2021;29(2):60-70.
Mehier C, Ract I, Metten MA, Najihi N, Guillin R. Primary anterior cruciate ligament repair: magnetic resonance imaging characterisation of reparable lesions and correlation with arthroscopy. Eur Radiol. 2022;32(1):582-92.
Samir M, Alieldin E, Ashour AT, Abouelnaga A, Attia A, Ashour A, et al. Ramp Lesions with ACL Injuries Between MRI and Arthroscopic Evaluation. Chirurgia (Bucur). 2024;119(eCollection):1.
Li LZ, Deng XT, Li Z, Liu JC. Single-staged arthroscopic treatment of simultaneous ruptures of the anterior cruciate ligament and the patellar tendon: A case report. Asian J Surg. 2022;45(10):1942-3.
Mittal R, Digge V, Selvanayagam R. Subintermeniscal Ligament Pullout Suture Technique for Anterior Cruciate Ligament Avulsion Fracture Fixation-AIIMS Technique. J Knee Surg. 2021;34(12):1355-8.
Deng NL, Zhang L, Sun J, Ma J, Zhang S, Liu XH, et al. [Tibialis anterior allograft versus hamstring tendon autograft for anterior cruciate ligament reconstruction:long-term clinical outcomes]. Zhongguo Gu Shang. 2021;34(3):269-74.
Saleh RT, Saffer ZM. Bracing versus non-bracing after anterior cruciate ligament reconstruction surgery. Adv Med J. 2020; 6(1): 47-52.
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Copyright (c) 2025 Muhammad Zeb, Syed Dil Bagh Ali Shah , Wajid Ullah, Imtiaz Ur Rehman, Zeeshan Khan (Author)

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