Additional lateral extra-articular tenodesis in revision ACL reconstruction does not influence the outcome of patients with low-grade anterior knee laxity

Eggeling, Lena; Drenck, Tobias C.; Frings, Jannik; Krause, Matthias; Korthaus, Alexander; Krukenberg, Anna; Frosch, Karl‐Heinz; Akoto, Ralph

doi:10.1007/s00402-021-04145-y

Cited by 21 publications

(54 citation statements)

References 34 publications

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“…The rate of complications remained low, with only one case (5.3%) experiencing residual pain and reoperation for a partial menisectomy. To date, few studies have analysed the results of revision ACLR and LET [12][13][14][15][16][17][18][19][20][21][22], with differences in graft type and surgical technique. Furthermore, selecting a uniform group of patients presents a challenge.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, several studies [8,[11][12][13][14][15][16][17][18][19][20][21][22] have emphasized the crucial role of simultaneous revision ACLR using an autologous graft and LET in improving rotational stability and graft protection. Despite these findings, the scientific evidence remains highly heterogenous, with variations in patient selection, graft type, and surgical technique.…”

Section: Introductionmentioning

confidence: 99%

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Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

Borim

Jubert

Vinaixa

et al. 2023

Eur J Orthop Surg Traumatol

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Background Most athletes who undergo revision of the anterior cruciate ligament reconstruction (ACLR) aim to return to their preinjury sport at a similar level of performance while minimizing the risk for reinjury. Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved outcomes and low complication rate. Yet, there are few series evaluating return-to-sport (RTS) and clinical outcomes after revision ACLR using bone-patellar tendon-bone (BPTB) and LET in athletes. Methods The study cohort consisted of 19 eligible athletes who had undergone their first revision ACLR using BPTB and LET (modified Lemaire) between January 2019 and 2020. Patients were prospectively followed and interviewed in a sports activity survey during a 2-year follow-up. Results Despite all patients returning to sports after revision ACLR surgery, 52.6% resumed playing at their preinjury level. Furthermore, patient-reported functional outcomes improved significantly following revision surgery, as evidenced by improvements in IKDC [64.4 (± 12) to 87.8 (± 6)], Lysholm [71.27 (± 12) to 84.2 (± 9.7)], and SF-12 scales [Physical: 53.3 (± 3) 57 (± 1.2); Mental: 50.2 (± 3.3) to 52.7 (± 2.4)]. One case (5.3%) experienced persistent pain and underwent reoperation for a partial meniscectomy. Conclusion After revision ACLR using autologous BPTB and LET, all active individuals are expected to RTS, similar to primary ACLR. The difference comes down to returning to the preinjury level, where the levels are lower depending on the sport and initial level of play. Good mid-term functional outcomes with a low complication rate can be expected in most cases. Study design Case series; Level of evidence IV. Ethical Committee Approval Number PR(ATR)79/2021 and HCB/2023/0173.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

Borim

Jubert

Vinaixa

et al. 2023

Eur J Orthop Surg Traumatol

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“…In patients undergoing ACL revision surgery with a low degree of instability (defined as a side-to-side difference of ≤ 5 mm and a pivot-shift grade of 1 and 2 on clinical examination), a LET (modified Lemaire) is considered unnecessary because it does not influence patient-related outcomes or failure rates [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, various studies report reduced failure rates, improved clinical outcomes, and a reduced incidence of postoperative pivot shift in patients with a high degree of instability (defined as a side-to-side difference of over 6 mm and a pivot-shift grade of 3) in whom LET was performed in addition to ACL revision [ 3 , 4 , 20 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

Controversies in ACL revision surgery: Italian expert group consensus and state of the art

et al. 2022

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Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors’ aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction. Methods A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants’ answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience. Conclusions The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case. Level of evidence V (Expert opinion).

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“…The extend of internal rotational laxity depends on individual anatomical characteristics (general joint laxity [ 37 ], tibial slope, femoral condyle shape [ 37 ], and mechanical alignment) as well as the traumatic lesions of anterolateral and intraarticular structures [menisci, iliotibial band, Kaplan fibers, capsule, and the anterolateral ligament (ALL)]. The ALL is a crucial peripheral rotational stabilizer of the knee joint [ 7 , 8 , 33 ], and has increasingly been investigated on in clinical context over the last years [ 10 , 34 , 41 , 48 , 49 ]. In cases of pronounced anterolateral rotational instability of the knee joint, a growing number of publications postulate a simultaneous reconstruction of the ALL and the ACL [ 15 , 16 , 22 , 32 , 36 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

Mayr

Hellbruegge²,

Haasters

et al. 2021

Arch Orthop Trauma Surg

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Purpose The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL. Study design Cross-sectional study, Level of evidence III. Methods In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05). Results 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78). Conclusion Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.

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Additional lateral extra-articular tenodesis in revision ACL reconstruction does not influence the outcome of patients with low-grade anterior knee laxity

Cited by 21 publications

References 34 publications

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

Controversies in ACL revision surgery: Italian expert group consensus and state of the art

Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

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