{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:27:59Z","timestamp":1792114079324,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,11,10]],"date-time":"2024-11-10T00:00:00Z","timestamp":1731196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare graft failure, nonrevision reoperation, complication, patient\u2010reported outcome measures (PROMs) and return to sports (RTS) between patients who underwent anterior cruciate ligament reconstruction (ACLR) with and without suture augmentation (SA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search was performed on PubMed, Cochrane, Embase and Web of Science databases from the inception of databases to 18 April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines. Studies comparing clinical outcomes of SA\u2010 and standard ACLR with a minimum 2\u2010year follow\u2010up were included. Data extraction and quality appraisal were performed by two researchers independently.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight retrospective cohort studies were included, with a total of 408 patients receiving SA\u2010ACLR and 443 patients receiving standard ACLR. A meta\u2010analysis of graft failure demonstrated a 62% relative risk reduction (RR [risk ratio], 0.38 [95% confidence interval {CI}, 0.19\u20130.73]; <jats:italic>p<\/jats:italic>\u2009=\u2009.004) in those receiving SA\u2010ACLR compared with standard ACLR. An age\u2010related heterogeneity in graft failure reduction was detected in the subgroup analysis, which was more pronounced in studies with mean ages of &lt;20 years compared with \u226520 years (<jats:italic>p<\/jats:italic>\u2009=\u2009.05; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200973.9%). No significant difference was observed in nonrevision reoperation or complication rates. No clinically relevant difference was observed in PROMs. SA\u2010ACLR was associated with a significantly higher RTS rate compared with the standard ACLR (RR, 1.12 [95% CI, 1.00\u20131.24]; <jats:italic>p<\/jats:italic>\u2009=\u2009.04), whereas no significant difference was observed in time to RTS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SA\u2010ACLR is associated with a reduced graft failure rate and increased RTS rate compared with standard ACLR without additional reoperations or complications. However, confidence in the evidence is limited by substantial heterogeneity. Future studies with a higher level of evidence are warranted to validate the benefit of SA and to determine the indication for different risk populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12537","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:51:02Z","timestamp":1731286262000},"page":"2799-2814","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Association of suture augmentation with graft failure and clinical outcomes following anterior cruciate ligament reconstruction: A systematic review and meta\u2010analysis of comparative studies with a minimum 2\u2010year 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