Summary: Combined ACLR+LET is associated with significant advantages over isolated ACLR in pediatric and adolescent patients, as a 12.8-fold reduction in graft rupture rates, better knee stability, and higher Tegner activity level with no increase in the rate of non-graft rupture related re-operations or complication

Young patients undergoing ACLR are at particularly high risk of graft rupture when compared to adults. Recent studies in adults have demonstrated significant reductions in graft rupture rates in high risk populations when a lateral extra-articular procedure is performed, but comparative studies in pediatric and adolescent populations do not exist. The purpose of this study was to compare the clinical outcomes of isolated ACLR versus combined ACLR+LET when using the Arnold-Coker modification of the MacIntosh procedure in young patients. The hypothesis was that combined procedures would be associated with a significantly reduced risk of graft rupture.

Methods

A retrospective analysis of prospectively collected data for consecutive pediatric and adolescent patients who underwent ACLR at (institution blinded for journal review), between January 1, 2013, and December 31, 2017 was conducted. Only patients with additional risk factors for graft rupture (high grade pivot shift grade, high level of sporting activity, participation in pivoting sports, and those with Segond fractures) were offered a LET in addition to ACLR. This was performed using the Arnold Coker modification of the MacIntosh procedure. All patients were recalled for in-office evaluation between September 2019 and June 2020. Clinical outcomes including graft-rupture rates, PROMS (state which ones), knee stability, return to sport rates, re-operation rates and complications were assessed. Comparisons between variables were assessed with Chi-square or the Fisher exact test for categorical variables and the Student test or Wilcoxon test for quantitative variables. Multivariate analyses were undertaken to evaluate risk factors for graft rupture.

Results

111 patients with a mean follow-up of 43.8 ± 17.6 months (range, 24-89 months) were included in the study. 40 patients underwent isolated ACLRs and 71 underwent ACLR+LET. The addition of an LET to ACLR was associated with a significantly lower graft rupture rate when compared to isolated ACLR (15% vs 0%, OR=16.96, 95% CI 1.91-142.85, P = .01), it was also associated with significantly better knee stability (rate of grade 3 pivot shift, 0% ACLR+ LET, 11% ACLR, p <0.01; side-to-side AP laxity difference >5mm 0% ACLR+LET, 17.2%, p=<0.01) and Tegner activity level (isolated ACLR, 6; ACLR+LET 7 P=.01). There were no significant differences exceeding known MCID thresholds with respect to any of the other outcome measures evaluated, and no differences in the rate of non-graft rupture related re-operations or complications between groups.

Conclusions

Combined ACLR+LET is associated with significant advantages over isolated ACLR in pediatric and adolescent patients. These advantages include a 16.9-fold reduction in graft rupture rates, better knee stability, and higher Tegner activity level with no increase in the rate of non-graft rupture related re-operations or complication

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Relationship Between Posterior Tibial Slope And Sagittal Plane Mechanics During Jump Landing After Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Robert A. Duerr, MD, UNITED STATES Jennifer Perry, MS, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES David C. Flanigan, MD, UNITED STATES Benjamin Ormseth, BS, UNITED STATES Robert Siston, PhD, UNITED STATES Andrew Garrone, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Laura C. Schmitt, PT, PhD, UNITED STATES
Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes Abstract Presentation 5 minutes Kyle Borque, MD, UNITED STATES Mary Jones, Msc Grad Dip Phys, UNITED KINGDOM Ganesh Balendra, MBBS, AUSTRALIA Lukas Willinger, MD, GERMANY Vitor Hugo Pinheiro, MD, UNITED KINGDOM Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM
MRI After ACL Reconstruction Demonstrates that Hamstring Grafts Heal and Integrate at Different Rates Abstract Presentation 6 minutes Sven Edward Putnis, MB ChB FRCS(Tr&Orth), UNITED KINGDOM Takeshi Oshima, MD, PhD, JAPAN Antonio Klasan, MD, AUSTRIA Samuel Grasso, PhD, B. Engineering (Mechanical), AUSTRALIA Thomas Neri, MD, PhD, Prof., FRANCE Myles R. J. Coolican, FRACS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA
Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population Abstract Presentation 6 minutes Ashley Bee Anderson, MD, UNITED STATES Travis Dekker, MD, UNITED STATES Veronika Pav, MS, UNITED STATES Timonthy C Mauntel, PhD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES John M. Tokish, MD, UNITED STATES Jon F. Dickens, MD, UNITED STATES
The Use Of An Internal Brace In A Single Bundle Hamstring Graft And Its Effect On Graft Healing At 1 Year After Anterior Cruciate Ligament Reconstruction ePoster Presentation Claire Bolton, FRACS, MBBS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA Bruno M. Giuffré, MD, AUSTRALIA
Age, Time From Injury To Surgery And Quadriceps Strength Affect The Risk Of Revision Surgery After Primary Acl Reconstruction Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Magnus Forssblad, SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Karl Eriksson, MD, PhD, Prof., SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN
Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Hana Marmura, BSc, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA Kurt Paul Spindler, MD, UNITED STATES Michael W Kattan, PhD, UNITED STATES Isaac Briskin, MA, UNITED STATES Dianne M. Bryant, PhD, CANADA
Value, Limitations And Recommendations For Use Of Metal-Reduction Knee MRI Sequences Following Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Brandon Zhao, MD, CANADA Nabil Khan, MBChB, MMED, FCS Orth, CANADA Mark F. Sommerfeldt, MD, CANADA Anukul Panu, MD, CANADA Jacob L Jaremko, MD, PhD, CANADA Catherine May Ting Hui, MD, FRCSC, CANADA
THE OUTCOME OF BALANCE EXERCISES AND AGILITY TRAINING FOR POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: CLINICAL ASSESSMENT Abstract Presentation 7 minutes SITI MAIZATUL AKMAL ISMAIL, Medical Science (Orthopaedic Surgery Sports), MALAYSIA

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Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Methods

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Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction

Methods

Results

Conclusions

More ISAKOS 2021: Global Content