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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The Lateral Femoral Notch Sign Entails Increased Rotatory Laxity After Acl-Injury. Pivot Shift Quantification With Surgical Navigation System Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, QATAR Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Luca Macchiarola, MD, ITALY Giacomo Dal Fabbro, MD, AUSTRALIA Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Charles Pioger, MD, FRANCE Johnny Rayes, MD, MSc, FEBOT, CANADA Ibrahim Haidar, MD, LEBANON Thomas Fradin, MD, FRANCE Cédric Ngbilo, MD, SWITZERLAND Thais Dutra Vieira, MD, FRANCE Etienne Cavaignac, MD,PhD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE
Creating A Crosswalk For Knee Outcomes After ACLR From The KOOS(5) To The IKDC-SKF Abstract Presentation 6 minutes Jessica L. Johnson, DPT, PhD, UNITED STATES Aaron Boulton, PhD, UNITED STATES Kurt Paul Spindler, MD, UNITED STATES Laura J. Huston, MS, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Laura Asplin, UNITED KINGDOM May Arna Risberg, PT, PhD, NORWAY Lynn Snyder-Mackler, PT, ScD, FAPTA, UNITED STATES
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
PSM: Pivot Shift Meter Cellphone Application for Classifying ACL Injuries Abstract Presentation 5 minutes Edmundo Berumen Nafarrate, PhD, Prof., MEXICO Carlos Alejandro Vega Najera, MD, MEXICO Joel Alejandro Cabral, MD, MEXICO Luis Sigala Gonzalez, Eng, MEXICO Ivan Ramos Moctezuma, Eng, MEXICO Carlos Leal, MD, Prof., COLOMBIA Jesus Javier Tonche, MD, MEXICO Avril Pérez Fontes, MD, MEXICO Fatima Quintana Trejo, Eng, MEXICO
Same Knee, Different Goals: Patients and Surgeons have Different Priorities Related to ACL Reconstructions and Surgeons are Resistant to Changing Clinical Practice Abstract Presentation 4 minutes Hana Marmura, MPT, PhD, UNITED STATES Dianne M. Bryant, PhD, CANADA Trevor B. Birmingham, PT, PhD, CANADA Kurt Paul Spindler, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Local Anaesthetic Infiltration (Lia) Is Equally Effective As Adductor Nerve Blocks For Pain Relief In Anterior Cruciate Ligament (Acl) Reconstructions. Abstract Presentation 8 minutes Mohammad Abou Salhab, MBChB, MSc, UNITED KINGDOM Sonal Sonwalkar , FRCA, UNITED KINGDOM Sanjeev Anand, MD, UNITED KINGDOM Martin Stone, MD, UNITED KINGDOM
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES

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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

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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