[Augmentation techniques: are they out?]

Basics of ligament augmentation are reviewed from the literature. As biomechanical in-vitro studies, animal experiments, and clinical studies show different designs and data, the results may be interpreted variably. Theoretically there is a positive effect of augmentation, but no significant improvement of clinical results is evident. The goal of our own prospective study was to check the healing capacity of a repaired and augmented ACL with respect to stability compared to a primary or secondary BTB ligament replacement with and without augmentation. 200 patients were allocated to 4 groups. In group I (G1) acute proximal ruptures were repaired arthroscopically and augmented with PDS II-cord. Patients in G2 received an acute and in G3 a late BTB ligament replacement. Additionally in G4 a late ligament replacement was augmented with a PDS II-cord. The clinical results reveal a comparative stability between G1 and G2, and gradually less stability in G3 and G4. Subjectively, knee function was felt best in G1 and G2 while being worst in G3 and G4. There is no significant difference in the mobility of knees between primary and secondary ligament replacement. An additional augmentation doesn't improve the knee stability.There is no positive effect of an augmentation technique of a biologic ligament replacement concerning stability, morbidity, complication rate, and costs. Very marginal freshly ruptured cruciate ligaments may be reinserted successfully by a biodegradable augmentation. Subjective feeling and functional stability may be at least equal to a primary ligament replacement. There are no advantages in knee mobility, when a secondary ligament replacement is performed.