Lateral extra-articular tenodesis may reduce graft failure after ACL reconstruction
BOSTON — Young active patients undergoing hamstring autograft ACL reconstruction with lateral extra-articular tenodesis experienced reduced graft failure and anterolateral rotatory laxity compared to patients who had ACL reconstruction alone, according to results presented at the American Orthopaedic Society for Sports Medicine.
Alan M. Getgood, MD, FRCS(Tr&Orth), and colleagues in the Stability Study Group randomly assigned 618 patients who were younger than 25 years old with an ACL-deficient knee to undergo standard hamstring tendon ACL reconstruction either with or without lateral extra-articular tenodesis. To be included in the study, patients had to have specific characteristics “that would potentially put them at a higher risk of reinjury,” according to Getgood.
“Those included two of the following three criteria: returning to contact pivoting sport; a high grade rotatory laxity, which is a pivot shift of grade 2 or greater; or they had to have generalized ligamentous laxity,” Getgood, consultant orthopedic surgeon at Fowler Kennedy Sports Medicine Clinic, told Healio.com/Orthopedics.
Patients were followed up at 3, 6, 12 and 24 months, with the primary outcome of clinical failure defined as persistent rotatory laxity including a positive pivot shift and graft failure, according to Getgood. He added secondary outcomes included graft failure on its own, the four-item pain intensity measure, KOOS and IKDC scores.
Getgood noted patients in the ACL reconstruction with lateral extra-articular tenodesis group had a reduction in clinical failure from 40% to 25% that equates to a relative risk reduction of 40%.
“The graft ruptures were reduced from 11% down to 4%, again a statistically significant [result] with a relative risk reduction of 66%,” Getgood said.
He also noted no clinically significant differences in patient-reported outcomes between the two groups.
“There were slight differences at 3 months and 6 months in favor of the ACL only group, but that was most likely associated with a slight delay in recovery,” Getgood said. – by Casey Tingle
Getgood AM, et al. Abstract 34. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Getgood reports he has no relevant financial disclosures.