Internal Brace Augmentation Versus Standard Anterior Cruciate Ligament Reconstruction: A Comparative Clinical Study in Young Active Patients

Background and aims: Anterior cruciate ligament (ACL) rupture is a common injury in young, active individuals, and arthroscopic ACL reconstruction (ACLR) is the standard of care. Internal brace augmentation has been proposed to enhance graft protection and potentially facilitate earlier return to sport, but comparative clinical data remain limited. This study aimed to compare early functional outcomes, knee stability, return to sports, and complications between internal brace augmentation ACLR and standard ACLR in patients with ACL rupture. Methods: This prospective comparative study was conducted at Medical College Kolkata, a tertiary care teaching hospital in Kolkata, India. Seventy patients with unilateral ACL rupture were analyzed: Group A (internal brace augmentation ACLR, n = 40) and Group B (standard ACLR, n = 30). Baseline demographics and injury characteristics were recorded. Functional outcomes (International Knee Documentation Committee (IKDC) and Lysholm scores) were assessed preoperatively and at six months. Knee range of motion (ROM), clinical stability tests (anterior drawer, Lachman, and pivot shift), time to return to sports, and postoperative complications were also evaluated. Between-group comparisons used Mann-Whitney U and chi-square or Fisher’s exact tests, with p < 0.05 considered significant. Result: Baseline characteristics, including age (27.00 ± 5.60 vs. 26.53 ± 3.07 years; p = 0.638), sex, side, and mechanism of injury, were comparable between groups. Preoperative IKDC scores were similar (49.48 ± 3.19 vs. 49.83 ± 3.19; p = 0.659), improving at six months to 78.98 ± 4.54 in Group A and 77.83 ± 6.72 in Group B (p = 0.858). Preoperative Lysholm scores (54.28 ± 3.29 vs. 54.57 ± 3.07; p = 0.672) improved to 88.88 ± 4.31 and 87.60 ± 6.58, respectively (p = 0.761). At six months, most patients achieved ROM 0-130° or 0-140° (39 (97.5%) Group A, 27 (90.0%) Group B; p = 0.288), and all had negative anterior drawer and Lachman tests; pivot shift was Grade 0 in 30 (75.0%) vs. 20 (66.7%) and Grade 1 in 10 (25.0%) vs. 10 (33.3%) (p = 0.445). Internal brace patients returned to sports significantly earlier (6.38 ± 0.98 vs. 8.20 ± 0.61 months; p < 0.001). Complications were low and comparable: knee stiffness 1 (2.5%) vs. 3 (10.0%) and effusion 3 (7.5%) vs. 2 (6.7%). Conclusion: Internal brace augmentation ACLR provides early functional outcomes, knee stability, and complication rates comparable to standard ACLR, with the added benefit of a significantly earlier return to sports. These findings support internal brace augmentation as a safe and effective option for young, active ACL rupture patients, while longer-term studies are warranted.