title: Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years.
abstract: BACKGROUND
  In recent years, the scientific discussion has focused on new strategies to enable a torn anterior cruciate ligament (ACL) to heal into mechanically stable scar tissue. Dynamic intraligamentary stabilization (DIS) was first performed in a pilot study of 10 patients. The purpose of the current study was to evaluate whether DIS would lead to similarly sufficient stability and good clinical function in a larger case series.
  
  
  METHODS
  Acute ACL ruptures were treated by using an internal stabilizer, combined with anatomical repositioning of torn bundles and microfracturing to promote self-healing. Clinical assessment (Tegner, Lysholm, IKDC, and visual analogue scale [VAS] for patient satisfaction scores) and assessment of knee laxity was performed at 3, 6, 12, and 24 months. A one-sample design with a non-inferiority margin was chosen to compare the preoperative and postoperative IKDS and Lysholm scores.
  
  
  RESULTS
  278 patients with a 6:4 male to female ratio were included. Average patient age was 31 years. Preoperative mean IKDC, Lysholm, and Tegner scores were 98.8, 99.3, and 5.1 points, respectively. The mean anteroposterior (AP) translation difference from the healthy contralateral knee was 4.7 mm preoperatively. After DIS treatment, the mean 12-month IKDC, Lysholm, and Tegner scores were 93.6, 96.2, and 4.9 points, respectively, and the mean AP translation difference was 2.3 mm. All these outcomes were significantly non-inferior to the preoperative or healthy contralateral values (p < 0.0001). Mean patient satisfaction was 8.8 (VAS 0-10). Eight ACL reruptures occurred and 3 patients reported insufficient subjective stability of the knee at the end of the study period.
  
  
  CONCLUSIONS
  Anatomical repositioning, along with DIS and microfracturing, leads to clinically stable healing of the torn ACL in the large majority of patients. Most patients exhibited almost normal knee function, reported excellent satisfaction, and were able to return to their previous levels of sporting activity. Moreover, this strategy resulted in stable healing of all sutured menisci, which could lower the rate of osteoarthritic changes in future. The present findings support the discussion of a new paradigm in ACL treatment based on preservation and self-healing of the torn ligament.
authors: Sonnenhof Orthopaedic Center, Department of Knee Surgery and Sports Traumatology, Buchserstrasse 30, CH-3006, Bern, Switzerland. philipphenle@sonnenhof.ch.
authors: Philipp
authors: P
authors: Henle
authors: Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland. christoph.roeder@memcenter.unibe.ch.
authors: Christoph
authors: C
authors: Röder
authors: Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland. gosia.perler@memcenter.unibe.ch.
authors: Gosia
authors: G
authors: Perler
authors: Sonnenhof Orthopaedic Center, Department of Knee Surgery and Sports Traumatology, Buchserstrasse 30, CH-3006, Bern, Switzerland. svenheitkemper@sonnenhof.ch.
authors: Sven
authors: S
authors: Heitkemper
authors: Sonnenhof Orthopaedic Center, Department of Knee Surgery and Sports Traumatology, Buchserstrasse 30, CH-3006, Bern, Switzerland. stefaneggli@sonnenhof.ch.
authors: Stefan
authors: S
authors: Eggli
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017060:Patient Satisfaction; D011474:Prosthesis Design; D020127:Recovery of Function; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult