Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return-to-Sport Rate to Anterior Cruciate Ligament Reconstruction Alone but a Lower Failure Rate Journal Articles uri icon

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abstract

  • PURPOSE: To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) would improve return-to-sport (RTS) rates in young, active patients who play high-risk sports. METHODS: This multicenter randomized controlled trial compared standard hamstring tendon ACLR with combined ACLR and LET using a strip of the iliotibial band (modified Lemaire technique). Patients aged 25 years or younger with an anterior cruciate ligament-deficient knee were included. Patients also had to meet 2 of the following criteria: (1) pivot-shift grade 2 or greater, (2) participation in a high-risk or pivoting sport, and (3) generalized ligamentous laxity. Time to return and level of RTS were determined via administration of a questionnaire at 24 months postoperatively. RESULTS: We randomized 618 patients in this study, 553 of whom played high-risk sports preoperatively. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR-LET (14%) groups; however, the graft rupture rate was significantly different (11.2% in ACLR group vs 4.1% in ACLR-LET group, P = .004). The most cited reason for no RTS was lack of confidence and/or fear of reinjury. A stable knee was associated with nearly 2 times greater odds of returning to a high-level high-risk sport postoperatively (odds ratio, 1.92; 95% confidence interval, 1.11-3.35; P = .02). There were no significant differences in patient-reported functional outcomes or hop test results between groups (P > .05). Patients who returned to high-risk sports had better hamstring symmetry than those who did not RTS (P = .001). CONCLUSIONS: At 24 months postoperatively, patients who underwent ACLR plus LET had a similar RTS rate to those who underwent ACLR alone. Although the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

authors

  • Rezansoff, Alex
  • Firth, Andrew D
  • Bryant, Dianne
  • Litchfield, Robert
  • McCormack, Robert G
  • Heard, Mark
  • MacDonald, Peter B
  • Spalding, Tim
  • Verdonk, Peter CM
  • Peterson, Devin
  • Bardana, Davide
  • Getgood, Alan MJ
  • Getgood, Alan MJ
  • Bryant, Dianne M
  • Litchfield, Robert
  • Willits, Kevin
  • Birmingham, Trevor
  • Hewison, Chris
  • Firth, Andrew D
  • Pinto, Ryan
  • Martindale, Ashley
  • O’Neill, Lindsey
  • Jennings, Morgan
  • Daniluk, Michal
  • McCormack, Robert G
  • Boyer, Dory
  • Zomar, Mauri
  • Heard, Mark
  • Buchko, Gregory M
  • Hiemstra, Laurie A
  • Kerslake, Sarah
  • Tynedal, Jeremy
  • MacDonald, Peter B
  • Stranges, Greg
  • McRae, Sheila
  • Brown, Holly
  • Rezansoff, Alex
  • Mohtadi, Nick
  • Chan, Denise
  • Garven, Alexandra
  • Peterson, Devin
  • Simunovic, Nicole
  • Duong, Andrew
  • Skelly, Matt
  • Shanmugaraj, Ajaykumar
  • Bardana, Davide
  • Howells, Fiona
  • Spalding, Tim
  • Thompson, Pete
  • Metcalfe, Andrew
  • Verdonk, Peter CM
  • Declerq, Geert

publication date

  • February 2024