Outcome after Combined Lateral Extra-articular Tenodesis and Anterior Cruciate Ligament Revision in Professional Soccer Players

Abstract

We report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score. The rate of return to sports and the level of play at final follow-up were recorded. ACL revision was performed with an autologous bone-patellar tendon-bone autograft or a hamstring graft. LET was performed using an extra-articular MacIntosh procedure as modified by Arnold-Coker. Anterior-posterior laxity was significantly reduced at the final clinical assessment ( < 0.0001): 22 patients (91.7%) had a negative pivot shift and 2 (8.3%) had residual glide (+), with significant improvement ( < 0.0001). The mean subjective IKDC and Lysholm score improved from 69.5 ± 11.1 (range: 56-90) to 88.4 ± 8.9 (range: 62.1-100) and from 58.1 ± 11.7 (range: 33-72) to 97.4 ± 3.2 (range: 88-100), respectively, with significant improvement ( < 0.0001) over preoperative values. The overall failure rate was 8.3%. There were no differences between mean preinjury and final TAS scores ( > 0.05). The rate of return to sports at the same level was 91.7% and the mean time to return to sports was 9.2 ± 2.2 months. Mid-term functional outcome after combined extra-articular reconstruction and ACL revision surgery was satisfactory, with a reduction in residual postoperative rotatory instability and degree of pivot shift.

Supplementary Lateral Extra-articular Tenodesis for Residual Anterolateral Rotatory Instability in Patients Undergoing Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials

“…Data on 818 patients, including 407 who underwent ACLR+LET and 411 who underwent ACLR, were pooled from 4 studies 4,18,45,46 that reported the postoperative side-to-side difference as measured using a KT-1000/-2000 arthrometer (Figure 6). At last follow-up, this measurement was not significantly different between the 2 groups (SMD, –0.43 [95% CI, –0.95 to 0.09]; P = .11), although heterogeneity was high for this outcome ( I 2 = 88%; P < .00001).…”

“…The results revealed no significant differences in terms of positive anterior laxity between the ACLR+LET and ACLR groups (RR, 0.76 [95% CI, 0.48-1.21]; P = .26). There was low to moderate heterogeneity among the studies ( I 2 = 40%; P = .17).…”

“…The pivot shift was dichotomized into positive (grades 2 or 3) or negative (grades 0 or 1) for meta-analysis. There was a 56% risk reduction for positive knee ALRI with ACLR+LET (RR, 0.56 [95% CI, 0.45-0.69]; P < .00001), and low heterogeneity was detected ( I 2 = 13%; P = .33).…”

“…Activity levels were compared using mean differences (MDs) and 95% CIs. Heterogeneity across individual studies was assessed using the I 2 statistic, with I 2 >50% considered significant. If heterogeneity was significant, data were analyzed using a random-effects model; otherwise, a fixed-effects model was applied.…”

ACL Reconstruction with Augmentation: a Scoping Review

“…Two failures occurred; one was caused by a new traumatic event and a second by septic arthritis. The rate of return to sport (at the same level) was 91.7% and the average time from surgery was an average of 9.2 months [15]. Guzzini et al [22] showed similar results in 16 elite female soccer players undergoing primary ACLR + LET.…”