2017 ISAKOS Biennial Congress ePoster #1010

 

Over-The-Top ACL Reconstruction Associated with Extra-Articular Lateral Tenodesis. Prospective Evaluation with 20-Year Minimum Follow-Up

Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, Bologna ITALY
Stefano Zaffagnini, MD, Prof., Bologna ITALY
Alberto Grassi, PhD, Bologna ITALY
Cecilia Signorelli, PhD, Bologna, BO ITALY
Federico Raggi, MD, Bologna ITALY
Tommaso Roberti di Sarsina, MD, Bologna ITALY
Giuseppe Carbone, MD, Bologna ITALY
Maurilio Marcacci, MD, Milano, Milano ITALY

Istituto Ortopedico Rizzoli, Bologna, BO, ITALY

FDA Status Cleared

Summary

Over-the-Top ACL Reconstruction associated with Extra-articular lateral tenodesis demonstrated a success rate of 84.3% at 20-year minimum follow-up. The lateral extra-articular plasty associated to ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.

Abstract

Introduction

There are few published studies with very long-term follow-up of combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction. The purpose of the present study was to analyze clinical and radiographic outcomes of over-the-top ACL reconstruction with extra-articular lateral tenodesis at minimum 20-year follow-up, and to evaluate the onset of osteoarthritis in this procedure, comparing these data with those at 5-year and 10-year minimum follow-up.
Study Design: Case series; Level of evidence, 4.

Methods

Fifty-two patients (M/F:41/11; mean age at final follow-up 51.5±7.6 years) who underwent double-stranded hamstrings over-the-top ACL reconstruction (leaving intact graft tibial insertions) with extra-articular lateral plasty (performed with the remnant part of tendons) were prospectively evaluated at a minimum 20-year (mean 24-year) follow-up. Twenty-nine patients were available for prospective clinical (Lysholm, Tegner and objective IKDC), instrumental (KT-2000) and radiographic (standard, long-standing and Merchant views) evaluations. Subjective KOOS and objective inertial sensors pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications/re-rupture/revision-surgery.

Results

At final follow-up mean Lysholm score was 85.7±14.6, median Tegner score was 4 (range 3-5), sport activity resumption was 82.6% and objective IKDC score was good or excellent (A or B) in 86% of patients. Only 3/26 patients (12%) had >5 mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9 m/s2 tibial acceleration side-to-side difference) in these 3/26 patients (12%). Statistically significant changes were: decrease in Tegner score from 5-year to 10-year follow-up from 7(range 6-8) to 4 (range 3-5) (P<.0001) and decrease in Lysholm score from 10-year to 20-year follow-up from 96.1±7.3 to 85.7±14.6 (P=.0003).
Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knee in patients with concomitant medial meniscectomy (n=8; 3.2±0.6 Vs. 5.0±1.8mm; P=.0114). No significant differences were reported regarding lateral or patellofemoral joint space.
One patient (2%) experienced re-rupture, 3/52 (5.8%) patients contralateral ACL injury (excluded from KT-2000 and radiographic evaluations). Overall composite

Objective

IKDC/KT-2000/re-rupture) failure rate was 15.7% (4/29 clinical failures and 1/52 re-rupture) at final follow-up.

Conclusion

Studied surgical technique demonstrated a success rate of 84.3% at 20-year minimum follow-up. The lateral extra-articular plasty associated to ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.