Summary

the results of our study show that in selected patients, superimposable results can be obtained between repair of ACL and anterolateral structures and reconstruction of ACL and LET.

Abstract

Background

Lateral extra-articular procedures (LEAPs) have been effective in reducing graft rupture rates in ACL reconstruction but the evidence supporting their role in ACL repair is sparse

Purpose

To compare clinical and radiological outcomes of ACL reconstruction and lateral extra-articualar tenodesis (ACLR+LET) against combined repair of the ACL and anterolateral structures (ACL+AL repair). The hypothesis was that patients undergoing ACL+AL repair would have non-inferior clinical and radiological outcomes with respect to IKDC scores, knee laxity parameters, and MRI characteristics. Furthermore, it was hypothesized that patients undergoing repair would have significantly better FJS-12 scores and shorter times to return to the pre-injury level of sport, without any increase in the rate of ipsilateral second ACL injury.
Study Design: Prospective comparative non-randomized study

Methods

Consecutive patients presenting with acute ACL tear were considered for study eligibility. ACLR+LET was only performed when intra-operative tear characteristics contra-indicated ACL repair. Patient reported outcome measures (PROMS), re-injury rates, anteroposterior side-to-side laxity difference and MRI characteristics were reported at a minimum follow up of two years

Results

One hundred patients (47 ACLR+LET, 53 ACL+AL Repair) with a mean follow-up of 25.2 months (range, 24-31)were enrolled and underwent surgery within 15 days of injury. At final follow up differences between groups with respect to the IKDC Score, anteroposterior side-to-side laxity difference, and signal-to-noise quotient (SNQ) did not exceed non-inferiority thresholds. ACL+AL repair was associated with shorter time to return to the pre-injury level of sport (ACLR+LET, mean, 9.5 months; ACL+AL repair, mean, 6.4 months; p<.001), better FJS-12 scores (ACLR+LET, mean, 97.4; ACL+AL repair, mean, 91.4 months; p=.04), and a higher proportion of patients achieving PASS for KOOS subdomains (symptoms, 88.2% vs 67.4%, p=.005; sport and recreational function, 94.1% vs 67.4%, p<.001; quality of life, 92.2% vs 73.9%, p=.01). There were no significant differences between groups with respect to ipsilateral second ACL injury rates (ACL+AL repair group 3.8% and ACLR+LET group, 2.1% (n=1), p=.63).

Conclusion

ACL+AL repair yielded clinical outcomes that were non-inferior (or not significantly different) to ACLR+LET with respect to IKDC Subjective, ACL RSI, Tegner and Lysholm scores, knee laxity parameters, graft maturity and rates of failure and re-operation. However, there were significant advantages of ACL+AL repair including shorter duration of time to return to the pre-injury level of sport, better FJS-12 scores, and a higher proportion of patients achieving PASS for KOOS subdomains (symptoms, sport and recreational function, quality of life).