Summary

Failure rate was almost 4 times lower for patients treated with a lateral augmentation alongside the revision ACLR in comparison to isolated revision ACLR. Although all patients returned to some sports practice, only almost 60% were able to maintain the same level according to the Tegner score at the last follow-up, whether with or without a lateral tenodesis.

Abstract

Introduction

After several years of disagreement about lateral extra-articular plasty (LEAP), we know that one of the main goals in the setting of Revision ACL-R is to reduce the failure rate. Therefore, the purpose of this study was to compare the failure rate, clinical outcomes and return to sports of a consecutive series of patients operated on for Revision ACL with and without a LEAP.

Materials And Methods

Patients treated with an isolated revision ACL-R between 2010 and 2015 (group 1) were compared to those treated with revision ACL-R associated with a Modified Lemaire LEAP between 2015 and 2019 (group 2). Surgical technique and graft used in primary ACL-R, revision ACL-R and lateral tenodesis were analyzed. Failure rate, determined as recurrent instability that required re-revision surgery was recorded. Subjective scores were calculated for Lysholm and International Knee Documentation Committee (IKDC) forms. Sport activity was evaluated through the Tegner Score.

Results

A total of 122 patients were included. Sixteen were lost in follow-up. Therefore, 42 patients in group 1 and 64 in group 2 were evaluated with a mean follow-up of 4.1 years (SD 2.1 years), 6.1 years (SD 2.2) for group 1 and 3.2 years (SD 0.9) for group 2. Mean age was 34 years (SD 8.9 years) for Group 1 and 29 years (SD 7.6 years) for Group 2. Failure rate was 23% (n=10) for Group 1 and 6.25% (n=4) for Group 2 (p 0.009) at a mean of 2.9 years. Mean pre and postoperative Lysholm score was 58 (SD 19) and 87 (SD 8.8) in Group 1 and 59 (SD 15) and 88 (SD 8.3) in Group 2 (p <0.01). Mean pre and postoperative IKDC scores were 51 (SD 13) and 81 (SD 10) in Group 1 and 54 (SD 14) and 82 (SD 9.4) in Group 2 (p <0.01). When comparing sport activity previous to the previous to the ACL-R and at final follow up, Tegner score decreased in 40.5% (43/106) of patients (43% in group 1 and 39% in group 2, p=0.1).

Conclusion

After a mean of 4 years follow-up, the failure rate after revision ACL-R was almost 4 times less when adding a LEAP. Although all patients returned to some sports practice, only almost 60% were able to maintain the same level according to the Tegner score at the last follow-up, whether with or without a LEAP.