2021 ISAKOS Biennial Congress ePoster
Quadriceps Tendon Autograft And Lateral Extra-Articular Tenodesis Are Becoming Increasingly Popular In Revision Acl Reconstruction
Philipp Wilhelm Winkler, MD, Linz AUSTRIA
Ryan Eads, MD, Pittsburgh, PA UNITED STATES
Thiago Vivacqua, MD, MSc, London, ON CANADA
Stephan Karsten Thomassen, MD, Kristiansand NORWAY
Lisa Lovse, MD, Saint Cloud, Minnesota UNITED STATES
Bryson P. Lesniak, MD, Presto, Pennsylvania UNITED STATES
Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, London, ON CANADA
Volker Musahl, MD, Prof., Pittsburgh, Pennsylvania UNITED STATES
UPMC, Pittsburgh , Pennsylvania , UNITED STATES
FDA Status Cleared
Summary
Quadriceps tendon autograft and concurrent lateral extra-articular tenodesis (LET) are becoming increasingly popular in revision ACL reconstruction; while LET use is associated with intact cartilage and severely abnormal preoperative knee laxity.
ePosters will be available shortly before Congress
Abstract
Background
Anterior cruciate ligament reconstruction (ACL-R) and subsequent ACL-R revisions are common orthopedic procedures. Revision ACL-R is linked to inferior patient reports outcomes (PROs) and increased residual laxity compared to primary ACL-R. Like most procedures, trends in revision ACL-R have changed overtime. An increased awareness of modifiable risk factors that can be addressed through technique alterations and combined procedures has driven these changes and needs to be further investigated.
Purpose
To evaluate trends in revision ACL- R, with emphasis on intra-articular findings, grafts, and concurrent procedures. It was hypothesized that revision ACL-Rs over time show a trend towards increased complexity with increased use of autografts over allografts.
Methods
This was a two-center retrospective study including patients undergoing revision ACL-R between 2010 and 2020. Demographic and surgical data including intra-articular findings and concurrent procedures were collected and compared for the time periods 2010-2014 and 2015-2020. All collected variables were compared between three pre-defined age groups (< 20 years, 20-30 years, > 30 years), right and left knees, and males and females. A time series analysis was performed to assess trends in revision ACL-R.
Results
This study included 260 patients with a mean age of 26.2 ± 9.4 years at the time of the most recent revision ACL-R, representing the first, second, third, and fourth revision ACL-R for 214 (82%), 35 (14%), 10 (4%), and 1 (< 1%) patients, respectively. Patients age > 30 years showed a significantly longer mean time from primary ACL-R to most recent revision ACL-R (11.1 years), compared to patients age < 20 years (2.2 years, p < 0.001) and age 20-30 years (5.5 years, p < 0.05). Quadriceps tendon autograft was used significantly more often in 2015-2020 compared to 2010-2014 (49% vs. 18%, p < 0.001). A high rate of concurrently performed procedures including meniscal repairs (45%), lateral extra-articular tenodesis (LET; 31%), osteotomies (13%), and meniscal allograft transplantations (11%) was shown. Concurrent LET was associated with intact cartilage and severely abnormal preoperative knee laxity and showed a statistically significant and linear increase over time (p < 0.05). Intact cartilage (41%, p < 0.05), concurrent medial meniscal repairs (39%, p < 0.05), and LET (35%, non-significant) were most frequently observed in patients aged < 20 years.
Conclusion
Quadriceps tendon autograft and concurrent LET are becoming increasingly popular in revision ACL-R, and the high rate of concurrent procedures observed demonstrates the high surgical demands of revision ACL-R. We consider additional procedures such as LET, HTO, meniscus transplant, or root repairs in high-grade rotatory knee laxity in the revision ACL setting.