Lateral extra-articular tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior knee instability

TY - JOUR

T1 - Lateral extra-articular tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior knee instability

AU - Alm, Lena

AU - Drenck, Tobias C

AU - Frosch, Karl-Heinz

AU - Akoto, Ralph

N1 - Copyright © 2020 Elsevier B.V. All rights reserved.

PY - 2020/10

Y1 - 2020/10

N2 - BACKGROUND: Additional lateral extra-articular procedures can reduce the risk of failure of primary anterior cruciate ligament reconstruction (ACLR). There is limited evidence on the effect of lateral extra-articular procedures in revision ACL surgery. The purpose of this study was to evaluate the clinical outcome of patients with lateral extra-articular tenodesis (LET) in combination with revision ACLR for combined ACL graft failure and high-grade anterior knee instability.METHODS: Between 2016 and 2018, 75 patients with graft failure after primary ACLR and high-grade anterior knee instability who received revision ACLR were included in the retrospective study. High-grade anterior knee instability was defined as high-grade pivot-shift or side-to-side difference of more than six millimeters in Rolimeter®-testing. An additional modified Lemaire tenodesis was performed in 59 patients during revision ACLR. Seventy-three patients were clinically examined with a minimum of two years after revision surgery.RESULTS: Failure of the revision ACLR occurred in 8.2% (n = 6) of the cases. LET lead to significant decreased failure rates (five percent vs. 21%, p = .045) and decreased incidence of a positive pivot-shift in patients with revision ACLR and high-grade anterior knee instability in comparison to patients without LET. Also, postoperative functional scores were significantly increased in the group of additional LET.CONCLUSIONS: Additional LET in patients with revision ACLR and high-grade anterior instability significantly reduces the risk of failure of revision ACLR, the incidence of pivot-shift and increases postoperative functional outcome.

AB - BACKGROUND: Additional lateral extra-articular procedures can reduce the risk of failure of primary anterior cruciate ligament reconstruction (ACLR). There is limited evidence on the effect of lateral extra-articular procedures in revision ACL surgery. The purpose of this study was to evaluate the clinical outcome of patients with lateral extra-articular tenodesis (LET) in combination with revision ACLR for combined ACL graft failure and high-grade anterior knee instability.METHODS: Between 2016 and 2018, 75 patients with graft failure after primary ACLR and high-grade anterior knee instability who received revision ACLR were included in the retrospective study. High-grade anterior knee instability was defined as high-grade pivot-shift or side-to-side difference of more than six millimeters in Rolimeter®-testing. An additional modified Lemaire tenodesis was performed in 59 patients during revision ACLR. Seventy-three patients were clinically examined with a minimum of two years after revision surgery.RESULTS: Failure of the revision ACLR occurred in 8.2% (n = 6) of the cases. LET lead to significant decreased failure rates (five percent vs. 21%, p = .045) and decreased incidence of a positive pivot-shift in patients with revision ACLR and high-grade anterior knee instability in comparison to patients without LET. Also, postoperative functional scores were significantly increased in the group of additional LET.CONCLUSIONS: Additional LET in patients with revision ACLR and high-grade anterior instability significantly reduces the risk of failure of revision ACLR, the incidence of pivot-shift and increases postoperative functional outcome.

U2 - 10.1016/j.knee.2020.06.005

DO - 10.1016/j.knee.2020.06.005

M3 - SCORING: Journal article

C2 - 33010761

VL - 27

SP - 1451

EP - 1457

JO - KNEE

JF - KNEE

SN - 0968-0160

IS - 5

ER -