Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction

Abstract

Background: There is evidence on the clinical effectiveness of the Lemaire technique for lateral extra-articular tenodesis (LET) in patients undergoing revision anterior cruciate ligament reconstruction (ACLR), but the best fixation technique is unknown. Purpose: To compare the clinical outcomes of 2 fixation techniques after revision ACLR: (1) onlay anchor fixation, which would avoid tunnel conflict and physis injury, and (2) transosseous tightening and interference screw fixation. Pain at the area of LET fixation was also assessed. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective 2-center study of patients with first-time revision ACLR and either LET with anchor fixation (aLET) with a 2.4-mm suture anchor or LET with transosseous fixation (tLET). Outcomes at minimum 12-month follow-up were assessed with the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain at the LET fixation area, Tegner score, and anterior tibial translation (ATT). A subgroup analysis within the aLET group investigated passing the graft over or under the lateral collateral ligament (LCL). Results: In total, 52 patients were included (26 patients in each group); the mean ± SD follow-up was 13.7 ± 3.4 months. No statistically significant differences were detected between the groups with respect to patient-reported outcome scores, clinical examination, or instrumented testing (side-to-side difference in ATT at 30° of flexion; aLET, 1.5 ± 2.5 mm; tLET, 1.6 ± 1.7 mm). Clinical failure was detected in 1 patient with aLET and none with tLET. Subgroup analysis revealed a small, nonsignificant flexion deficit in knees in which the iliotibial band strand was passed under (n = 42) or over (n = 10) the LCL. No clinically relevant tenderness was detected at the area of LET fixation in any group (aLET, 0.6 ± 1.3; tLET, 0.9 ± 1.7; over the LCL, 0.2 ± 0.6; under the LCL, 0.9 ± 1.6). Conclusion: Onlay anchor fixation and transosseous fixation of the LET were equivalent with respect to outcome scores and instrumented ATT testing. Clinically, there were minor differences in passage of the LET graft over or under the LCL.

Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis

“…For example, the developed lateral tibiofemoral contact pressures after LET or the impact of ITB debilitation to knee loading due to graft harvesting are debatable topics that we could address [ 28 , 37 ]. The same holds true for surgical choices such as femoral graft fixation using overlay anchor fixation instead of femoral tunnel drilling, and the LET graft passage beneath or over the LCL [ 54 ]. Moreover, in the scope of this work we developed a loading profile that seems to trigger the desired PS movement for the given knee model.…”

Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device

“…Metallic staples can cause irritative lateral pain, pose a risk of damaging the ACL tunnel and may undergo mobilization [57]-a phenomenon that can also occur with suture anchors or interference screws. In the literature, there is limited clinical and biomechanical evidence of the superiority of one fixation method over another, with only one study conducted by Behrendt et al [58] directly comparing onlay anchor fixation and transosseous interference screw fixation, which did not find any differences in terms of Tegner score and anterior tibial translation. Our modification utilizes an indirect femoral fixation method employing the high-resistance sutures of the ACL-reconstruction femoral extracortical fixation device.…”