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Does the Anterolateral Tenodesis Really Influence the ACL Maturation Process?

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Anterolateral tenodesis (ALT) added to anterior cruciate ligament (ACL) reconstruction does not impact ACL graft maturation on MRI scans. This study found no significant differences in graft healing or integration between isolated ACL repair and ACL repair with ALT.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biomedical Engineering

Background:

  • Controversy exists regarding the effect of anterolateral tenodesis (ALT) on anterior cruciate ligament (ACL) graft maturation.
  • Some studies suggest delayed maturation with ALT, while others report no significant impact.

Purpose of the Study:

  • To determine if ALT affects ACL graft maturation using MRI.
  • To assess interobserver agreement in MRI analysis of ACL graft maturation.

Main Methods:

  • 168 patients undergoing ACL reconstruction (117 isolated, 51 with ALT) between 2018-2021.
  • Radiological evaluation of graft maturation and integration via MRI.
  • Independent assessment by two orthopedic surgeons and two radiologists to evaluate interobserver variability.

Main Results:

  • No significant differences in Howell ligamentization scale or signal-to-noise quotient (SNQ) between isolated ACL reconstruction and ACL reconstruction with ALT.
  • No differences observed in tendon-bone healing at the fibrous interzone.
  • Slight interobserver agreement was noted among the four evaluators.

Conclusions:

  • The addition of anterolateral tenodesis to ACL reconstruction does not alter ACL graft maturation as evaluated by MRI.
  • Findings suggest ALT does not negatively influence the biological healing process of ACL grafts on imaging.