Effect of Lateral Extra-articular Tenodesis on the Rate of Revision Anterior Cruciate Ligament Reconstruction in Elite Athletes

Borque, Kyle A.; Jones, Mary; Laughlin, Mitzi S.; Balendra, Ganesh; Willinger, Lukas; Pinheiro, Vítor; Williams, Andy

doi:10.1177/03635465221128828

Cited by 32 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2012, 79% of patients received HT autograft while in 2016 that number dropped to 32%, with BPTB representing 61% of all ACLR grafts that year. The study of LET as an augment to HT ACLR represents an important innovation in response to inferior outcomes with HT alone and has consistently demonstrated lower failure rates than HT alone [12, 22, 23]. These results reflect why HT + LET acts more like BPTB than HT alone or other types of grafts in predictive models of graft failure/revision surgery.…”

Section: Discussionmentioning

confidence: 99%

External validation of the Norwegian anterior cruciate ligament reconstruction revision prediction model using patients from the STABILITY 1 Trial

Martin,

Marmura,

Wastvedt

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeA machine learning‐based anterior cruciate ligament (ACL) revision prediction model has been developed using Norwegian Knee Ligament Register (NKLR) data, but lacks external validation outside Scandinavia. This study aimed to assess the external validity of the NKLR model (https://swastvedt.shinyapps.io/calculator_rev/) using the STABILITY 1 randomized clinical trial (RCT) data set. The hypothesis was that model performance would be similar.MethodsThe NKLR Cox Lasso model was selected for external validation owing to its superior performance in the original study. STABILITY 1 patients with all five predictors required by the Cox Lasso model were included. The STABILITY 1 RCT was a prospective study which randomized patients to receive either a hamstring tendon autograft (HT) alone or HT plus a lateral extra‐articular tenodesis (LET). Since all patients in the STABILITY 1 trial received HT ± LET, three configurations were tested: 1: all patients coded as HT, 2: HT + LET group coded as bone‐patellar tendon‐bone (BPTB) autograft, 3: HT + LET group coded as unknown/other graft choice. Model performance was assessed via concordance and calibration.ResultsIn total, 591/618 (95.6%) STABILITY 1 patients were eligible for inclusion, with 39 undergoing revisions within 2 years (6.6%). Model performance was best when patients receiving HT + LET were coded as BPTB. Concordance was similar to the original NKLR prediction model for 1‐ and 2‐year revision prediction (STABILITY: 0.71; NKLR: 0.68–0.69). Concordance 95% confidence interval (CI) ranged from 0.63 to 0.79. The model was well calibrated for 1‐year prediction while the 2‐year prediction demonstrated evidence of miscalibration.ConclusionWhen patients in STABILITY 1 who received HT + LET were coded as BPTB in the NKLR prediction model, concordance was similar to the index study. However, due to a wide 95% CI, the true performance of the prediction model with this Canadian and European cohort is unclear and a larger data set is required to definitively determine the external validity. Further, better calibration for 1‐year predictions aligns with general prediction modelling challenges over longer periods. While not a large enough sample size to elicit the true accuracy and external validity of the prediction model when applied to North American patients, this analysis provides more support for the notion that HT plus LET performs similarly to BPTB reconstruction. In addition, despite the wide confidence interval, this study suggests optimism regarding the accuracy of the model when applied outside of Scandinavia.Level of EvidenceLevel 3, cohort study.

show abstract

Section: Discussionmentioning

confidence: 99%

External validation of the Norwegian anterior cruciate ligament reconstruction revision prediction model using patients from the STABILITY 1 Trial

Martin,

Marmura,

Wastvedt

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

show abstract

“…At 2 years of follow-up, in a pivoting non-elite sports population, Porter et al 33 found better patient-reported outcome measures (PROMs) in patients who had a LET. Recently, Borque et al 7 found that the addition of LET reduced the risk of undergoing revision by 2.8 times in elite athletes undergoing primary ACLR, suggesting the status as an elite athlete should be included as a potential indication for a LET, as they are at increased risk for ACL graft failure. In a previous study, 4 there was also no delay in RTP in cases with additional LET.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction

Pinheiro,

Borque,

Laughlin

et al. 2023

Am J Sports Med

Self Cite

View full text Add to dashboard Cite

Background: A number of studies have investigated return to play after anterior cruciate ligament reconstruction (ACLR) in professional soccer players, but it is unclear which factors are associated with a return to the preinjury performance and ability to play over time. Purpose: To identify factors that contribute to a professional soccer player's return to preinjury performance after ACLR, as well as to report their playing performance at 2 and 5 years after ACLR compared with their preinjury performance. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of professional soccer players undergoing primary ACLR were analyzed between 2005 and 2019. A minimum 2-year follow-up was required. The effect of patient, surgical, and postoperative factors on performance rates, defined as a combination of league level and playing time, was evaluated with univariate and multivariate logistic regression models. Results: A total of 200 male professional soccer players were included. When combining league level and playing time, 30% of athletes returned to their preinjury performance at 2 years and 22% at 5 years. However, 53% of athletes returned to their preinjury performance for at least 1 season by year 5. At 2 years, a chondral lesion of grade 3 or 4 decreased the odds of return to preinjury performance (odds ratio [OR], 0.37; P = .010). Athletes receiving an ACLR with the addition of a lateral extra-articular tenodesis procedure were 2.42 times more likely to return to preinjury performance at 2 years than athletes with ACLR alone ( P = .004). By 5 years after ACLR, athletes aged ≥25 years at the time of reconstruction were 3 times less likely to be performing at their preinjury performance (OR, 0.32; P < .001), and those with a grade ≥3 chondral lesion were >2 times less likely to be performing at their preinjury performance (OR, 0.43; P = .033). Conclusion: The presence of >50% thickness chondral pathology, ACLR without lateral extra-articular tenodesis, and age >25 years at the time of surgery were all significant risk factors of worse performance rates after ACLR. Significant decreases in performance rates were noted at 2 and 5 years postoperatively.

show abstract

“…Therefore, the femoral tunnel was the focus of this study. Second, recent research has placed emphasis on the anterolateral ligament (ALL) as a potential contributor to residual rotatory laxity following ACL injury [3, 4, 16, 21]. Conversely, some studies have suggested that the contribution of the ALL to rotatory knee laxity may be negligible [1, 2].…”

Section: Discussionmentioning

confidence: 99%

Satisfactory outcomes after one‐stage revision anterior cruciate ligament reconstruction using rectangular tunnel technique

Okimura,

Suzuki,

Ikeda

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Purpose One-stage revision anterior cruciate ligament reconstruction (ACLR) with the anatomic rectangular tunnel (RT) technique using bone-patellar tendon-bone (BTB) grafts results in anatomically precise tunnel placement and secure graft fixation. This study evaluated knee joint laxity and clinical outcomes in terms of femoral tunnel overlap. It was hypothesised that there would be no significant differences in knee joint laxity or clinical outcomes regardless of femoral tunnel overlap. Methods Between 2012 and 2021, a single surgeon conducted 196 one-stage revision ACLRs with the RT technique using BTB grafts. Patients were divided based on the presence of femoral tunnel overlap. Knee joint laxity was evaluated using the Lachman test, pivot shift test, and side-to-side difference measured with a KT-1000 arthrometer. Clinical outcomes were assessed using the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Knee Examination Form 2000. Knee joint laxity and clinical outcomes were compared between groups after a median follow-up of 2.5 years (range 2.0-8.0). ResultsThe study included 30 and 73 patients in the overlap and non-overlap groups, respectively. No significant differences were observed in the results of the Lachman test, pivot shift test, or KT-1000 arthrometer as well as in the Lysholm, KOOS, or IKDC scores between the two groups. Based on the IKDC scores, all patients were graded as normal or nearly normal. Conclusion One-stage revision ACLR with the RT technique using BTB grafts improved knee joint laxity and had favourable clinical outcomes regardless of femoral tunnel overlap. To achieve optimal results in one-stage revision ACLR, it is crucial to create a tunnel within the anatomical attachment area and ensure proper graft fixation and tensioning. Level of evidence III.

show abstract

Effect of Lateral Extra-articular Tenodesis on the Rate of Revision Anterior Cruciate Ligament Reconstruction in Elite Athletes

Cited by 32 publications

References 35 publications

External validation of the Norwegian anterior cruciate ligament reconstruction revision prediction model using patients from the STABILITY 1 Trial

External validation of the Norwegian anterior cruciate ligament reconstruction revision prediction model using patients from the STABILITY 1 Trial

Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction

Satisfactory outcomes after one‐stage revision anterior cruciate ligament reconstruction using rectangular tunnel technique

Contact Info

Product

Resources

About