Summary

A significant improvement in functional performance and level of activity was seen in a retrospective case-series of ACL reconstruction with an added lateral tenodesis at 2-year follow-up

Abstract

Background

A significant failure rate after anterior cruciate ligament (ACL) reconstruction gives a persisting focus on improving surgical techniques. Lateral extraarticular tenodesis (LET) has increased in popularity as an addition to intraarticular reconstruction - with biomechanical and clinical outcomes supporting its use. Technical variation in procedures, such as type of graft fixation, can affect outcomes and therefore the effectiveness of the added procedure.

Purpose

The aim of the current study was to investigate functional performance and level of activity in patients surgically treated with a combined ACL reconstruction and lateral extraarticular tenodesis using a novel biocomposite screw for femoral graft fixation.

Study Design:
Retrospective case-series, Level of evidence IV.

Methods

All patients surgically treated with an ACL reconstruction and a LET, using a novel biocomposite screw (Biosure Regenosorb, Smith and Nephew) for femoral graft fixation, at our clinic with a 2-year follow-up were eligible for inclusion. Indication for adding the LET was “high-risk profile” meaning patients with one or more of the following: (a) desired a return to level 1 sports, (b) had a high-grade knee laxity, (c) had a hyperlaxity or (d) underwent revision surgery. Further, patient treated with concomitant surgery to other ligaments or with other LET graft fixational methods were excluded. IKDC subjective score, KOOS score and Tegner Activity Scale was collected at 2-year follow-up.

Results

A total of 27 patients were included, nineteen primary ACL reconstructions (15 patellar tendon /4 hamstring) combined with LET and eight revision surgeries combined with LET. Time from surgery to follow-up was a mean of 720 days (SD 230 days). Twenty-one of patients were female, the average age at surgery was 24.9 years (SD 8.7 years). None of patients reported complications or any donor site morbidity related to the tenodesis or its fixation. At follow-up 7 patients were deemed as failure due to renewed laxity or graft failure seen at second-look arthroscopy. Mean preoperative IKDC, KOOS-Sports and Recreation and KOOS-Quality of Life was 47.3 (SD 12.6), 32.6 (SD 23.7) and 30.9 (SD 15.0) respectively. At the follow-up evaluation, a significant improvement in IKDC to 82.2 (SD 13.1), KOOS- Sports and Recreation to 73.1 (SD 24.3) and KOOS-Quality of Life to 67.8 (SD 21.6) was found (All P<0.001). Tegner Activity Scale had a median score of 7 preinjury, 3 at the preoperative visit and 6 at the follow-up evaluation.

Conclusion

A significant improvement in functional performance and level of activity was seen after ACL surgery with an added LET (with a biocomposite screw fixation) in this “high-risk” group of patients. A somewhat lower PROM score and higher failure rate than conventionally seen after primary ACL-reconstruction reflects the higher complexity in of the current cohort.