4Purpose: The purpose of this work was to develop the rationale for adding a lateral extra-5 articular tenodesis to an ACL reconstruction in a knee with an injury that included both the 6 ACL and anterolateral structures, and to show the early clinical picture. 7Methods: The paper includes a review of recent anatomical and biomechanical studies of 8 the anterolateral aspect of the knee. It then provides a detailed description of a modified 9Lemaire tenodesis technique. A short-term clinical follow up of a case and control group was 10 performed, with two sequential groups of patients treated by isolated ACL reconstruction, and 11 by combined ACL plus lateral tenodesis. 12

Background: The increased prevalence of anterior cruciate ligament (ACL) reconstruction has led to an increased need for revision ACL reconstructions. Despite the growing body of literature indicating that single-stage revision ACL reconstruction can yield good outcomes, there is a lack of data for determining when and how to safely perform a single-stage revision. Purpose: To assess the outcomes, graft failure rates, and return-to-play rates of a decision-making algorithm for single-stage revision ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We reviewed a consecutive series of revision ACL reconstructions performed by the senior author between September 2009 and July 2016 with minimum 2-year follow-up. All patients were assessed, and decision making was undertaken according to the algorithm. Outcomes measured were further surgery, graft rerupture, re-revision, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS). For the elite athlete population, return-to-play time, duration, and level of play after surgery as compared with preinjury were also determined. Results: During this period, 93 procedures were performed in 92 patients (40 elite athletes). Two 2-stage procedures were undertaken, leaving 91 single-stage procedures (91 patients) to form the basis for further study. At a mean 4.3 years (SD, 2.2 years) after surgery, there had been 2 re-revisions (2.2%) and 2 further instances of graft failure that had not been re-revised (total graft failure rate, 4.4%). There were 17 subsequent procedures, including 6 arthroscopic partial meniscectomies, 5 removals of prominent implants, and 1 total knee arthroplasty. The mean Tegner score was 8.02 before graft rerupture and 7.1 at follow-up. At follow-up, the mean KOOS outcomes were 79.3 for Symptoms, 88.0 for Pain, 94.2 for Activities of Daily Living, 73.6 for Sport, and 68.9 for Quality of Life. Of 40 elite athletes, 35 returned to play at a mean 11.2 months (SD, 3.6 months) after surgery. Conclusion: Single-stage revision ACL reconstructions can be performed reliably in the majority of patients, with good clinical outcomes, low rerupture rates, and high-return-to play rates, even in the elite athlete population.

Background: There is a paucity of data regarding return to play (RTP), level of competition, and longevity of play after revision of anterior cruciate ligament (ACL) reconstruction (ACLR) in elite athletes. Purpose: To report RTP rates and competition levels in elite athletes at the point of RTP, as well as at 2 and 5 years after revision ACLR, and the effect of meniscal and chondral pathology at revision surgery on these outcomes. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of a consecutive series of all revision ACLRs undertaken by the senior author between 2009 and 2019, with a minimum 2-year follow-up, was carried out. Outcome measures were RTP rates and competition level. Results: A total of 49 knees in 48 elite athletes met the inclusion criteria. After revision ACLR, 43 (87.8%) elite athletes achieved RTP, of whom 75.5% were at the same level. At 2 years after surgery, 39 (79.6%) were still playing, 25 (51%) at the same level; at 5 years after surgery, 20 (44.4%) were still playing, 9 (20%) at the same level. Elite athletes with <50% thickness or no articular cartilage lesions were more likely to RTP (94.6% vs 66.7%; P = .026), as well as return to the same competition level (83.8% vs 50%; P = .047), compared with those with ≥50% thickness chondral lesions. Those without medial meniscal pathology were more likely to RTP at the same level after revision surgery (94.4% vs 64.5%; P = .036). The median time elite athletes continued to play after revision ACLR was 73 months (95% CI, 43.4-102.6); 23 months at the same level (95% CI, 13.6-32.4). The probability of still playing at 5 years after surgery was 55.9%, with a 22.5% chance of maintaining preinjury competition level. Conclusion: In elite athletes, RTP rates and competition level decreased over time after revision ACLR. The presence of >50% thickness chondral pathology was associated with lower RTP rates and competition level at RTP time, while medial meniscal pathology was associated with lower competition level at RTP.

While not statistically significant, these results suggest that the intervention for employees at high risk of STD achieves practical and clinical significance by achieving absolute and relative reductions in risk of STD of 3% and 15%, respectively.

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