Summary
A retrospective study analyzed patients with ACL ruptures undergoing ACL reconstruction combined with a LEAP procedure. A total of 108 patients were enrolled, with 66 undergoing anatomical ALL-reconstruction and 42 undergoing ITB-tenodesis. There were no statistically significant differences observed between the ALL-R group and the ITB-T group in PROMs, complications, and failure rate.
Abstract
Introduction
Anterior cruciate ligament (ACL) reconstruction is a prevalent orthopedic procedure driven by the increasing incidence of ACL injuries. Despite its success in restoring knee stability and function, complications and the risk of reinjury remain. Lateral extra-articular procedures (LEAP) like anatomical ALL-reconstruction (ALL-R) and ITB-tenodesis (ITB-T) have been shown to reduce re-rupture rates. However, there is a lack of comparative studies examining the clinical outcomes between these two techniques. This study aims to compare clinical and patient-reported outcome measures (PROMs), complications, failure rate, and revision rate between both techniques, hypothesizing no significant difference between the two methods.
Materials & Methods
A retrospective study analyzed patients with ACL ruptures undergoing ACL reconstruction combined with a LEAP procedure. The inclusion criteria comprised patients aged between 16 and 50 years, diagnosed with a clinically and radiologically confirmed ACL rupture and comprehensive clinical outcome data. A total of 108 patients were enrolled, with 66 undergoing ALL-R and 42 undergoing ITB-T. Clinical outcome scores included International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Tegner score, and NRS pain scale. Data was collected at baseline, 12 months, and 24 months. The primary outcome was the re-rupture of the graft. Secondary outcome was the re-operation rate (meniscal tears, cyclops...) up to 24 months post-operatively.
Results
There were no statistically significant differences observed in IKDC, Lysholm, Tegner, and NRS scores at any of the time points between the two groups. Both groups demonstrated significant improvement in IKDC from preoperatively to 3 months postoperatively. Pain levels during activity significantly decreased for both groups from preoperatively (ALL: 43.2 ± 2.6, ITB: 41.8 ± 3.2) to 3 months postoperatively (ALL: 25.7 ± 3.0, ITB: 23.9 ± 3.4).
At the 12-month follow-up, the ALL-R group experienced 1 re-rupture, which involved a RAMP-repair per-operatively. By the 24-month follow-up, 2 additional re-ruptures were reported. For the ITB-T group, no re-ruptures were observed at the 12-month follow-up, but 2 re-ruptures occurred by the 24-month follow-up, both of which involved a RAMP-repair per-operatively. No statistical difference in re-rupture percentage was found between both groups.
In the ALL-R group, 4 re-operations were performed by the 12-month follow-up: 3 for cyclops lesions and 1 for medial meniscectomy after repair. For the ITB-T group, no re-operations were reported at 12-months, but 1 re-operation for medial meniscectomy after repair occurred at the 24-month follow-up. The odds ratio is approximately 2.4, suggesting that the odds of a re-operation are higher in the ALL-R group compared to the ITB-T group; however, this difference was not statistically significant (p = 0.64).
Discussion
As anticipated, there were no statistically significant differences observed between the ALL-R group and the ITB-T group in terms of functional outcomes, complications, revision, and failure rate. This suggests that both lateral extra-articular procedure (LEAP) techniques are similarly effective in treating ACL ruptures with rotatory instability. Notably, re-ruptures involving medial meniscal RAMP lesions were observed in both groups, warranting further investigation into their significance.