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


CONCLUSIONS
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.
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.
Kathrin S
KS
Bieri
Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland.
Stefan M
SM
Scholz
Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
Sandro
S
Kohl
Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Emin
E
Aghayev
Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Lukas P
LP
Staub
D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D062707:Return to Work / Q000191:economics / Q000706:statistics & numerical data; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult
ACL repair; ACL surgery timing; Anterior cruciate ligament; Dynamic intraligamentary stabilization; Ligamys; Return to work; Work capacity