2021 ISAKOS Biennial Congress ePoster
Lower failure rates after adding a lateral extra-articular augmentation to revision ACL reconstruction: a comparative series
Juan Pablo Zicaro, MD, Olivos, Buenos Aires ARGENTINA
Ignacio Garcia-Mansilla, MD, La Lucila, Buenos Aires ARGENTINA
Carlos H. Yacuzzi, MD, Buenos Aires, BA ARGENTINA
Matias Costa-Paz, MD, PhD., Buenos Aires, Buenos Aires ARGENTINA
Hospital Italiano de Buenos Aires, CABA, Buenos Aires, ARGENTINA
FDA Status Not Applicable
Summary
Failure rate was 3 times lower for patients treated with a lateral augmentation alongside with the revision ACLR in comparison to isolated revision ACLR. Even though this difference was not statistically significant (p=0.6), we believe the results are clinically relevant. Clinical outcomes and return to sports were similar for both groups.
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Abstract
Introduction
Despite many authors agree that revision ACL reconstruction (ACL-R) is the main indication of a lateral extra articular augmentation, only few comparative studies have been reported. Besides providing a more stable knee, the main goal of a lateral augmentation is to reduce the failure rate. Therefore, the purpose of this study was to compare the failure rate, clinical outcomes and return to sports of a consecutive series of patients treated for revision ACL with and without a lateral augmentation.
Materials And Methods
A total of 36 consecutive patients prospectively enrolled in our revision ACL reconstruction patient registry were identified for study purposes. Patients treated with isolated revision ACLR between 2014 and 2015 (group 1) were compared to those treated with revision ACLR associated with a LEAP between 2015 and 2016 (group 2).
Surgical technique and graft used in primary ACLR, revision ACLR and lateral augmentation (lateral tenodesis or anatomical anterolateral ligament reconstruction) were analyzed. Failure rate, determined as recurrent instability that required re-revision surgery was recorded. Subjective scores were calculated for Lysholm, Tegner, and International Knee Documentation Committee (IKDC) forms. KT-1000 measurements were performed as well as clinical examination. Postoperative magnetic resonance images (MRI) were obtained at one-year follow-up to assess graft incorporation.
Results
Eighteen patients were evaluated in each group with a mean follow-up of 53 months (range 37-73 months). Lateral augmentation was performed with an ilio-tibial band tenodesis in 13 cases and in 5 cases with an allograft reconstruction. Median age was 30.5 years (IQR 27-36 years) for Group 1 and 26.5 years (IQR 24-33 years) for Group 2. Failure rate was 17% (n=3) for Group 1 and 5.5% (n=1) for Group 2 (p 0.6) at a mean of 24 months. Median pre and postoperative Lysholm score was 65 (IQR 61-72) and 91 (IQR 87-98) in Group 1 and 72 (IQR 53-75) and 90 (IQR 79-95) in Group 2 (p 0.1). Median pre and postoperative IKDC score was 55 (IQR 45-65) and 80 (IQR 74-94) in Group 1 and 56 (IQR 48-67) and 76 (IQR 68-84) in Group 2 (p 0.11). Sixteen (89%) patients return to sports in each group. The MRI shown and homogeneous neoligament in 66% (n=12) of patients in group 1 and 61% (n=11) in group 2 (p 0.8).
Conclusion
Failure rate was 3 times lower in patients treated with a lateral augmentation alongside with the revision ACLR in comparison to isolated revision ACLR. Even though this difference was not statistically significant (p=0.6), we believe the results are clinically relevant. Clinical outcomes and return to sports were similar for both groups.