2023 ISAKOS Biennial Congress Paper
Isolated Lateral Extra-articular Tenodesis (LEAT) for Chronic Rotational Instability following Primary Anterior Cruciate Ligament (ACL) Reconstruction has Low Surgical Morbidity and Improves Knee Stability
Ashley Iain Simpson, BA(Hons), MBBS, MSc, MA(Cantab), FRCS(Tr&Orth) UNITED KINGDOM
Cameron Muirhead, MD, Perth AUSTRALIA
Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, Claremont, WA AUSTRALIA
Orthopaedic Research Foundation of Western Australia, Perth, AUSTRALIA
FDA Status Not Applicable
Summary
The isolated LEAT procedure appears appropriate and successful in addressing ongoing subjective and objective rotational instability in the ACL reconstructed knee
Abstract
Background
Augmentation of the lateral structures of the knee using a Lateral Extra-Articular Tenodesis (LEAT) in combination with ACL reconstruction is thought to improve rotational instability, though the exact indications for LEAT remain controversial. We propose that the LEAT procedure can also be used in isolation in the ACL reconstructed knee with an intact graft but mild to moderate chronic subjective and objective rotational instability. This procedure ideally provides sufficient adjunctive knee stability while avoiding the higher surgical morbidity, complication rate and prolonged post-operative rehabilitation of full revision ACL reconstruction.
Methods
A prospective consecutive case series of patients undergoing isolated LEAT by a single surgeon for chronic rotational instability following previous ACL reconstruction were followed from 2016 to 2022. Inclusion criteria consisted of an ACL reconstruction with appropriately placed bone tunnels and intact graft on MRI, with subjective knee instability and positive pivot shift on clinical examination. Patient demographics, pre-operative imaging, pre- and post-operative patient-reported outcome measures (PROMs) were analysed.
Results
Twelve patients were identified. Mean age was 29.3 years (Range: 20-41 years) and 50% were male. A modified MacIntosh LEAT was used for all patients. The mean time from ACL reconstruction to the LEAT procedure was 68 months. Mean follow up time was 15.5 months (Range: 8-59 months). In all patients the pivot shift was obliterated post-LEAT procedure. Four patients underwent concomitant meniscal repair (33%) and three patients underwent meniscal debridement (25%) at the same operation. No complications were reported but one patient is awaiting removal of interference screw for superficial irritation. Significant improvements were demonstrated in PROMS including Sane, Tegner, ACL-RSI and EQ-5D scores.
Conclusions
The isolated LEAT procedure appears appropriate and successful in addressing ongoing subjective and objective rotational instability in the ACL reconstructed knee with intact graft and appropriate tunnel positioning and is a useful option in this cohort of patients. It offers a low surgical morbidity and complication rate in comparison to revision ACL reconstruction and provided good patient-reported outcomes across a series of measures. This study is the largest of its kind in the available published literature.