Summary: Combined ACLR+LET is associated with significant advantages over isolated ACLR in pediatric and adolescent patients, as a 12.8-fold reduction in graft rupture rates, better knee stability, and higher Tegner activity level with no increase in the rate of non-graft rupture related re-operations or complication

Young patients undergoing ACLR are at particularly high risk of graft rupture when compared to adults. Recent studies in adults have demonstrated significant reductions in graft rupture rates in high risk populations when a lateral extra-articular procedure is performed, but comparative studies in pediatric and adolescent populations do not exist. The purpose of this study was to compare the clinical outcomes of isolated ACLR versus combined ACLR+LET when using the Arnold-Coker modification of the MacIntosh procedure in young patients. The hypothesis was that combined procedures would be associated with a significantly reduced risk of graft rupture.

Methods

A retrospective analysis of prospectively collected data for consecutive pediatric and adolescent patients who underwent ACLR at (institution blinded for journal review), between January 1, 2013, and December 31, 2017 was conducted. Only patients with additional risk factors for graft rupture (high grade pivot shift grade, high level of sporting activity, participation in pivoting sports, and those with Segond fractures) were offered a LET in addition to ACLR. This was performed using the Arnold Coker modification of the MacIntosh procedure. All patients were recalled for in-office evaluation between September 2019 and June 2020. Clinical outcomes including graft-rupture rates, PROMS (state which ones), knee stability, return to sport rates, re-operation rates and complications were assessed. Comparisons between variables were assessed with Chi-square or the Fisher exact test for categorical variables and the Student test or Wilcoxon test for quantitative variables. Multivariate analyses were undertaken to evaluate risk factors for graft rupture.

Results

111 patients with a mean follow-up of 43.8 ± 17.6 months (range, 24-89 months) were included in the study. 40 patients underwent isolated ACLRs and 71 underwent ACLR+LET. The addition of an LET to ACLR was associated with a significantly lower graft rupture rate when compared to isolated ACLR (15% vs 0%, OR=16.96, 95% CI 1.91-142.85, P = .01), it was also associated with significantly better knee stability (rate of grade 3 pivot shift, 0% ACLR+ LET, 11% ACLR, p <0.01; side-to-side AP laxity difference >5mm 0% ACLR+LET, 17.2%, p=<0.01) and Tegner activity level (isolated ACLR, 6; ACLR+LET 7 P=.01). There were no significant differences exceeding known MCID thresholds with respect to any of the other outcome measures evaluated, and no differences in the rate of non-graft rupture related re-operations or complications between groups.

Conclusions

Combined ACLR+LET is associated with significant advantages over isolated ACLR in pediatric and adolescent patients. These advantages include a 16.9-fold reduction in graft rupture rates, better knee stability, and higher Tegner activity level with no increase in the rate of non-graft rupture related re-operations or complication

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Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Caiqi Xu, MD, CHINA Tom Gale, MS, UNITED STATES William Anderst, PhD, UNITED STATES Freddie H. Fu, MD, UNITED STATES
Outcomes Following Anterior Cruciate Ligament Reconstruction in Young Patients: An Observational Study. ePoster Presentation Kunal Mohan, MB MCh MRCSI, IRELAND David Cooper, MB MRCSI, IRELAND Niall McGoldrick, MB MCh FRCS (Tr & Orth), IRELAND Martin Davey, MB MCh MRCSI, IRELAND Megan Diack, MBCHB, MRCSI, MCh, IRELAND Paula McQuail, MB FRCSI, IRELAND Fintan J. Shannon, FRCS (Tr/Orth), IRELAND
Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population Abstract Presentation 6 minutes Ashley Bee Anderson, MD, UNITED STATES Travis Dekker, MD, UNITED STATES Veronika Pav, MS, UNITED STATES Timonthy C Mauntel, PhD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES John M. Tokish, MD, UNITED STATES Jon F. Dickens, MD, UNITED STATES
Negative Effects Of Delayed Anterior Cruciate Ligament Reconstruction On Associated Injuries And Knee Laxity Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Per-Mats Janarv, MD, PhD, Associate Prof., SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Magnus Forssblad, SWEDEN Anders Stalman, MD, PhD, Professor, SWEDEN
Value, Limitations And Recommendations For Use Of Metal-Reduction Knee MRI Sequences Following Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Brandon Zhao, MD, CANADA Nabil Khan, MBChB, MMED, FCS Orth, CANADA Mark F. Sommerfeldt, MD, CANADA Anukul Panu, MD, CANADA Jacob L Jaremko, MD, PhD, CANADA Catherine May Ting Hui, MD, FRCSC, CANADA
Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
Contralateral versus ipsilateral quadriceps graft, for anterior cruciate ligament reconstruction. Abstract Presentation 6 minutes Franco Della Vedova, ARGENTINA Hernan Galan, MD, ARGENTINA Daniel A. Slullitel, MD, Prof., ARGENTINA
THE OUTCOME OF BALANCE EXERCISES AND AGILITY TRAINING FOR POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: CLINICAL ASSESSMENT Abstract Presentation 7 minutes SITI MAIZATUL AKMAL ISMAIL, Medical Science (Orthopaedic Surgery Sports), MALAYSIA
Bone Marrow Aspiration Concentrate Augmentation in Anterior Cruciate Ligament Hamstring Autograft Reconstruction: Clinical and Functional Outcomes of a Cohort Study Abstract Presentation 5 minutes David H. Figueroa, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE Sergio Arellano, MD, CHILE Alex Vaisman, MD, Prof., CHILE Francisco Figueroa, MD, CHILE Nicolas Zilleruelo, MD, CHILE Rafael Calvo, MD, CHILE

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Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Methods

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Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Methods

Results

Conclusions

More ISAKOS 2021: Global Content