Editorial Commentary: Suture Tape Augmentation Enhances Recovery After Anterior Cruciate Ligament Surgery and Is Cost-Effective, While Biologic Augmentation Requires Well-Powered Controlled Trials

Adding a biologic “mix” to facilitate anterior cruciate ligament (ACL) graft healing in bone tunnels is a promising option. Of course, optimization of graft healing in the femoral and tibial tunnels may or may not translate into a better biologic ACL graft. Specifically, after biologic tunnel augmentation, does the graft itself revascularize and remodel more rapidly to allow early return to sport earlier, which could justify the increased cost of biologic augmentation? This remains an unknown. While biologics require further investigation, what is known is that suture tape augmentation protects ACL grafts at higher loads by increasing construct stiffness to avoid elongation, whereas most low loads enhancing graft incorporation and healing are experienced by the grafts. Clinically, recent research shows that suture tape augmentation of ACL quadriceps autograft (without biologics) in young athletes (with an average age of 17) showed no graft retears at a 3-year follow-up and 90% return to sport, and suture tape augmentation is inexpensive.