Additional lateral extra-articular tenodesis in revision ACL reconstruction does not influence the outcome of patients with low-grade anterior knee laxity

Abstract

Introduction There is limited evidence on the indications of lateral extra-articular tenodesis (LET) in revision ACLR. The aim of this study was to evaluate the influence of the LET in patients with revision ACLR with preoperative low-grade anterior knee laxity. Methods Between 2013 and 2018, 78 patients who underwent revision ACLR with preoperative low-grade anterior knee laxity [≤ 5 mm side-to-side difference (SSD)] were included in the retrospective cohort study. An additional modified Lemaire tenodesis was performed in 23 patients during revision ACLR and patients were clinically examined with a minimum of 2 years after revision surgery. Postoperative failure of the revision ACLR was defined as SSD in Rolimeter® testing ≥ 5 mm or pivot-shift grade 2/3. Results In total, failure of the revision ACLR occurred in 11.5% (n = 9) of the cases at a mean follow-up of 28.7 ± 8.8 (24–67) months. Patients with an additional LET and revision ACLR did not show a significantly reduced failure rate (13% vs. 11%) or an improved clinical outcome according to the postoperative functional scores or pain in regards to patients with an isolated revision ACLR (Tegner 5.7 ± 1.3 vs. 5.9 ± 1.5, n.s.; IKDC 77.5 ± 16.2 vs. 80.1 ± 14.9, n.s., Lysholm 81.9 ± 14.2 vs. 83.8 ± 14.5, n.s.; VAS 1.9 ± 2.2 vs. 1.2 ± 1.7, n.s.). Conclusions An additional LET in patients with revision ACLR with low-grade anterior knee laxity does not influence patient-related outcomes or failure rates. Subjects with preoperative low-grade anterior knee laxity may not benefit from a LET in revision ACLR. Level of evidence III

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

“…The rate of complications remained low, with only one case (5.3%) experiencing residual pain and reoperation for a partial menisectomy. To date, few studies have analysed the results of revision ACLR and LET [12][13][14][15][16][17][18][19][20][21][22], with differences in graft type and surgical technique. Furthermore, selecting a uniform group of patients presents a challenge.…”

“…In recent years, several studies [8,[11][12][13][14][15][16][17][18][19][20][21][22] have emphasized the crucial role of simultaneous revision ACLR using an autologous graft and LET in improving rotational stability and graft protection. Despite these findings, the scientific evidence remains highly heterogenous, with variations in patient selection, graft type, and surgical technique.…”

Controversies in ACL revision surgery: Italian expert group consensus and state of the art

“…In patients undergoing ACL revision surgery with a low degree of instability (defined as a side-to-side difference of ≤ 5 mm and a pivot-shift grade of 1 and 2 on clinical examination), a LET (modified Lemaire) is considered unnecessary because it does not influence patient-related outcomes or failure rates [ 20 ].…”

“…Conversely, various studies report reduced failure rates, improved clinical outcomes, and a reduced incidence of postoperative pivot shift in patients with a high degree of instability (defined as a side-to-side difference of over 6 mm and a pivot-shift grade of 3) in whom LET was performed in addition to ACL revision [ 3 , 4 , 20 – 23 ].…”

Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

“…The extend of internal rotational laxity depends on individual anatomical characteristics (general joint laxity [ 37 ], tibial slope, femoral condyle shape [ 37 ], and mechanical alignment) as well as the traumatic lesions of anterolateral and intraarticular structures [menisci, iliotibial band, Kaplan fibers, capsule, and the anterolateral ligament (ALL)]. The ALL is a crucial peripheral rotational stabilizer of the knee joint [ 7 , 8 , 33 ], and has increasingly been investigated on in clinical context over the last years [ 10 , 34 , 41 , 48 , 49 ]. In cases of pronounced anterolateral rotational instability of the knee joint, a growing number of publications postulate a simultaneous reconstruction of the ALL and the ACL [ 15 , 16 , 22 , 32 , 36 , 38 ].…”