Summary

High risk patients with revision ACL reconstruction using quadriceps tendon autograft and lateral extraarticular tenodesis do just as well as lower risk controls.

Abstract

Introduction

High rates of clinical failure and graft rupture remain a problem with isolated ACL reconstruction (ACLR) in at-risk populations. There is therefore a renewed enthusiasm for lateral extra-articular tenodesis (LET) which provides additional extra-articular restraint to better control anterolateral rotational laxity in at-risk cases including revision ACLR. There is a lack of high quality comparative evidence to support this rationale. The purpose of this study is to compare clinical outcomes and return to sport in patients who undergo revision ACL reconstruction with LET compared to those without LET (control group).

Methods

All patients who underwent revision ACL reconstruction with and without LET between January 2018 and February 2020 were queried at our institutional registry. The LET group was compared to the control group (revision ACLR without LET) and followed for a minimum of 24 months post-surgery to evaluate patient reported outcome measures, satisfaction, return to sports, rate of reoperation, and psychological readiness for return to sport (using the ACL-Return to Sport after Injury Scale, ACL-RSI).

Results

A total of 81 patients with a mean follow-up of 2.75 years were included. LET group contained 37 patients (76% female) with a mean age of 26.6 years and BMI of 23.5 kg/m^2 compared to 44 patients (80% female) with mean age of 28.2 years and BMI of 26.9 kg/m^2. There were no significant differences between the LET and control groups with respect to mean post-operative PROMIS Pain Interference (47.7 vs 48.3, p=0.46) and PROMIS Mobility scales (53.3 vs 52.9, p=0.97). In addition, there were no differences in post-operative IKDC (78.9 vs 78.3, p=0.45), Marx (7.9 vs 7.2, p=0.64), or SANE (73.1 vs 74.2, p=0.38) scores. The same held true with regards to post-operative ACL-RSI scores between the groups (43.3 vs 50.1, p=0.38). Return to play rates after revision ACLR were similar in the LET group compared to the control group (55% vs 45%, p=0.40) with similar confidence to play their pre-injury sport (scale out of 100, 58.2 vs 56.2, p=0.82).

Conclusion

Satisfaction and patient reported outcome scores after revision ACL reconstruction are good with or without LET. While both groups have similar rates of return to play and reoperation at greater than 2-year follow-up, these results suggest the addition of LET to revision ACLR may provide similar outcomes in high-risk patients when compared to isolated revision ACL reconstruction.