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Published on: April 30, 2014
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Lateral Extra-articular Tenodesis Does Not Decrease Graft Failure in Revision Anterior Cruciate Ligament
Thiago Alberto Vivacqua1, Philipp W Winkler2, Gian Andrea Lucidi3
1Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
Summary
Revision anterior cruciate ligament reconstruction (R-ACLR) with lateral extra-articular tenodesis (LET) showed similar failure and return-to-sport rates as isolated R-ACLR. The R-ACLR-LET group had improved functional outcomes, but routine use is not recommended.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Biomechanical engineering
Background:
- Revision anterior cruciate ligament reconstruction (R-ACLR) is complex, with varying outcomes.
- Lateral extra-articular tenodesis (LET) is a potential adjunct procedure to improve stability.
- High-grade pivot-shift findings indicate significant rotatory instability.
Purpose of the Study:
- To compare return-to-sport (RTS) rates, graft failure, and clinical outcomes between R-ACLR with LET and isolated R-ACLR.
- To evaluate the efficacy of adding LET to R-ACLR in patients with persistent instability.
Main Methods:
- Retrospective review of 74 patients undergoing R-ACLR with or without LET.
- Inclusion criteria: high-grade positive pivot-shift test and minimum 2-year follow-up.
- Outcome measures included RTS rates, graft failure, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores.
Main Results:
- No significant difference in failure rates between R-ACLR (12.8%) and R-ACLR with LET (11.4%).
- No significant difference in return-to-sport (RTS) rates between the groups.
- R-ACLR with LET demonstrated significantly higher KOOS ADL (97.2 vs 93.5) and KOOS Sport (74.3 vs 63.0) scores.
Conclusions:
- Revision ACLR with LET demonstrates comparable failure and RTS rates to isolated R-ACLR.
- The addition of LET to R-ACLR may improve functional outcomes, particularly in daily activities and sports.
- Routine recommendation of the modified Lemaire LET procedure in R-ACLR is not supported by this study.
