Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up

Zaffagnini, Stefano; Muccioli, Giulio Maria Marcheggiani; Grassi, Alberto; Sarsina, Tommaso Roberti di; Raggi, Federico; Signorelli, Cecilia; Urrizola, Francisco; Spinnato, Paolo; Rimondi, Eugenio; Marcacci, Maurilio

doi:10.1177/0363546517723013

Cited by 109 publications

(149 citation statements)

References 58 publications

(90 reference statements)

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“…The results of our study are supported by the long-term outcomes of LET reported by Zaffagnini et al 35 and Devitt et al 4 Zaffagnini et al 35 reported on the 20-year outcomes after combined hamstring ACLR and LET, noting no association between LET and lateral or patellofemoral compartment OA. Similarly, Devitt et al 4 performed a systematic review evaluating long-term follow-up studies after ACLR and LET, noting no association between LET and lateral compartment OA.…”

Section: Discussionsupporting

confidence: 88%

Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy

Shimakawa

Burkhart

Dunning

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Modified Lemaire lateral extra-articular tenodesis (LET) has been proposed as a method of addressing persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR). However, concerns remain regarding the potential for increasing lateral compartment contact pressures. Purpose: To investigate changes in tibiofemoral joint contact pressures after isolated ACLR and combined ACLR plus LET with varying states of a lateral meniscal injury. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knee specimens (mean age, 60.0 ± 3.4 years) were utilized for this study, with specimens potted and loaded on a materials testing machine. A pressure sensor was inserted into the lateral compartment of the tibiofemoral joint, and specimens were loaded at 0°, 30°, 60°, and 90° of flexion in the following states: (1) baseline (ACL- and anterolateral ligament–deficient), (2) ACLR, (3) ACLR with LET, (4) partial meniscectomy (removal of 50% of the posterior third of the lateral meniscus), (5) subtotal meniscectomy (removal of 100% of the posterior third of the lateral meniscus), and (6) LET release (LETR). Mean contact pressure, peak pressure, and center of pressure were analyzed using 1-way repeated-measures analysis of variance. Results: Across all flexion angles, there was no statistically significant increase in the mean contact pressure or peak pressure after ACLR plus LET with and without lateral meniscectomy compared with isolated ACLR. There was a significant reduction in the mean contact pressure, from baseline, after subtotal meniscectomy (69.72% ± 19.27% baseline; P = .04) and LETR (65.81% ± 13.40% baseline; P = .003) at 0° and after the addition of LET to ACLR at 30° (61.20% ± 23.08% baseline; P = .031). The center of pressure was observed to be more anterior after partial (0°, 30°) and subtotal (0°, 60°) meniscectomy and LETR (0°, 30°, 60°). Conclusion: Under the loading conditions of this study, LET did not significantly alter lateral compartment contact pressures when performed in conjunction with ACLR in the setting of an intact or posterior horn–deficient lateral meniscus. Clinical Relevance: This study should provide surgeons with the confidence that it is safe to perform LET in this manner in conjunction with ACLR without altering lateral compartment pressures, regardless of the status of the lateral meniscus.

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Section: Discussionsupporting

confidence: 88%

Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy

Shimakawa

Burkhart

Dunning

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Long-term follow-up reports have recently been published. Zaffagnini et al 32 recently reported minimum 20-year outcome data on 52 patients undergoing the Marcacci procedure. Objective International Knee Documentation Committee (IKDC) scores were good or excellent in 86% of patients (31%, A; 55%, B).…”

Section: Clinical Results Of Lateral Extra-articular Proceduresmentioning

confidence: 99%

Clinical Results of Lateral Extra-Articular Tenodesis

Batty

Lording

2018

Techniques in Orthopaedics

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In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some patients, however, have ongoing instability or suffer graft rupture. Failure after ACL reconstruction is multifactorial, but residual anterolateral rotatory laxity is 1 potential contributing factor. Lateral extra-articular procedures are a heterogenous group of operations that were initially described as isolated treatments for the ACL deficient knee, and subsequently used in combination with intra-articular reconstructions. Initial observational studies were encouraging, however, comparative studies were less flattering and lead to a general abandonment of these procedures. With improved understanding of the anatomy and biomechanics of the anterolateral capsuloligamentous complex there has been a renewed interest in these procedures. Recent systematic reviews suggest efficacy of these procedures in improving rotational control, though data showing improved patient reported outcomes or reduced graft rupture rates are lacking. Preliminary results from ongoing clinical trials are supportive for lateral extra-articular tenodesis when used as an augment to modern, intra-articular ACL reconstructions in targeted, high-risk patients.

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“…These changes could result in early arthritic changes. Zaffagnini et al [11] presented a series of 52 patients who had "over the top" ACLR + LET procedure. All had a minimum of 22 years follow-up.…”

Section: Lateral Extra-articular Tenodesis Proceduresmentioning

confidence: 99%

ACL Reconstruction with Augmentation: a Scoping Review

Riediger

Stride

Coke

et al. 2019

Curr Rev Musculoskelet Med

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Purpose of Review We reviewed the recent literature to identify and summarize new research surrounding anterior cruciate ligament reconstruction (ACLR) with augmentation in the form of additional soft tissue procedures or biologic augmentation. Specifically, we wanted to review the failure rates of these procedures in both the primary and revision settings. Methods The databases Embase, PubMed, and Medline were searched on August 13, 2018, for English-language studies that reported on the use of anterior cruciate ligament reconstruction (primary and revision) in conjunction with either soft tissue or biologic augmentation. The studies were systematically screened and data abstracted in duplicates. Recent Findings Advancements in ACLR surgery, including soft tissue augmentation, may decrease primary and revision surgery failure rates for high-risk patients. The use of biological augmentation has shown histologic and radiographic improvements. These differences, however, have failed to be statistically significant and have not resulted in clinically significant improvements in outcome. Summary The limited body of evidence has shown that the addition of soft tissue procedures may in fact lower the risk of graft rerupture rates particularly in revision or in patients wishing to return to high-risk sports and activities. The use of biologic augmentation although promising in laboratory studies has yet to show any significant clinical results and therefore will require further studies to prove any efficacy.

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Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up

Abstract: Studied surgical technique demonstrated good results in laxity control at 20-year minimum follow-up. The lateral extra-articular plasty associated with ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.

Cited by 109 publications

References 58 publications

Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy

Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy

Clinical Results of Lateral Extra-Articular Tenodesis

ACL Reconstruction with Augmentation: a Scoping Review

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