2025 ISAKOS Biennial Congress ePoster
Clinical Outcomes And Risk Factors For Failure In Anterior Cruciate Ligament Reconstruction Combined With An All-Soft Tissue Lateral Extrarticular Tenodesis: A Retrospective Cohort Study
Edoardo Monaco, MD, Rome ITALY
Alessandro Carrozzo, MD, Assist. Prof., Rome ITALY
Valerio Nasso, Roma, RM ITALY
Susanna Pagnotta ITALY
Alessandro Annibaldi, MD ITALY
Andrea Ferretti, Prof., Rome, RM ITALY
Nicola Maffulli, MD, PhD, MS, FRCS(Orth), London UNITED KINGDOM
La Sapienza University, ROme, ITALY
FDA Status Cleared
Summary
This study found that combining ACL reconstruction with LET results in improved clinical outcomes and a low graft failure rate, with professional athletes and those with chondral lesions identified as being at higher risk for graft failure.
Abstract
Objectives:
The purpose of this study was to evaluate the clinical outcomes of patients undergoing anterior cruciate ligament (ACL) reconstruction combined with an all-soft tissue lateral extra articular tenodesis (LET) using the modified MacIntosh-Coker-Arnold technique. In addition, the study aimed to identify risk factors associated with graft failure after the procedure.
Methods
A retrospective analysis was performed on consecutive patients who underwent ACL reconstruction with anterolateral tenodesis at our institution between January 2013 and June 2022. Inclusion criteria included patients with acute or chronic ACL injuries confirmed by clinical examination and MRI. Exclusion criteria included multiligament injuries and revisions of previous ACL reconstructions. Clinical outcomes were assessed using subjective scores (KOOS, IKDC, Lysholm) and objective assessments (Lachmeter) at a minimum follow-up of two years. Statistical analysis was performed to identify risk factors for graft failure.
Results
The final cohort included 328 patients with a mean follow-up of 72.4 ± 30.3 months. The rate of graft failure was 3.4% (11 patients). High preoperative Tegner activity scores and professional athletic status were significant risk factors for failure with odds ratios of 6.82 and 5.89, respectively. The presence of chondral lesions was also associated with an increased risk of graft failure. The majority of patients (91.5%) achieved acceptable clinical outcomes as indicated by the Patient Acceptable Symptoms State (PASS) thresholds for IKDC and KOOS scores.
Conclusion
ACL reconstruction combined with anterolateral tenodesis results in favorable clinical outcomes with a low graft failure rate compared to isolated ACL reconstruction. High physical activity and the presence of chondral lesions are significant risk factors for graft failure. These findings support the use of anterolateral tenodesis in high-risk populations to improve postoperative stability and reduce the risk of reinjury.