2015 ISAKOS Biennial Congress Paper #0

The Addition Of Either An Anterolateral Ligament Reconstruction or An Iliotibial Band Tenodesis Is Associated With A Lower Failure Rate After Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Trial

Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Marcel F. Sobrado, MD, PHD, São Paulo, SP BRAZIL
Vitor Barion Castro De Padua, MD, Marilia, SP BRAZIL
Tales Mollica Guimarães, MD, Caieiras, São Paulo BRAZIL
Andre Giardino Moreira Da Silva, MD, São Paulo, São Paulo BRAZIL
Marcelo B. Bonadio, MD, São Paulo, SP BRAZIL
José R. Pécora, Prof., São Paulo, SP BRAZIL
Riccardo Gomes Gobbi, MD, PhD, São Paulo, SP BRAZIL
Gilberto L. Camanho, MD, São Paulo, SP BRAZIL
University of São Paulo, São Paulo, São Paulo, BRAZIL

FDA Status Cleared

Summary: Patients who underwent revision ACL reconstruction with a laterally based augmentation procedure had a lower failure rate than patients who underwent isolated revision ACL reconstruction

Abstract:

Purpose

To compare the failure rate in patients who underwent revision anterior cruciate ligament (ACL) reconstruction alone or associated with an extra-articular procedure. Secondary objectives were to compare ACL laxity, patient-reported outcome measures, and complication rates in these patients and, subsequently, to compare the outcomes of patients who underwent revision ACL reconstruction associated with anatomical anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET).

Methods

This was a retrospective comparative study. Patients were classified into two groups, according to whether (Group 2) or not (Group 1) an extra-articular reconstruction was performed. Patients who underwent an extra-articular procedure were further divided into ALL reconstruction (Group 2A) and LET (Group 2B). Baseline demographic variables, operative data and post-operative data were evaluated.

Results

The groups with (86 patients) and without (88 patients) an associated extra-articular reconstrcution had similar preoperative data. Group 2 had a lower failure rate (4.6%vs.14.7%;p=0.038), better KT-1000, better pivot shift, and better Lysholm. There was no difference regarding complications, except more lateral pain in Group 2. Regarding the groups who underwent ALL reconstruction (41 patients) and LET (46 patients), Group 2A showed better Lysholm scores. Both groups had similar failure rates and complications.

Conclusion

Patients who underwent revision ACL reconstruction with a laterally based augmentation procedure had a lower failure rate than patients who underwent isolated revision ACL reconstruction. KT-1000 and pivot shift examination were also significantly better when a lateral augmentation was performed. Complications were similar except for an increase in lateral pain in the augmented group. No clinically important differences were found when comparing the LET group to the ALL group other than a statistical improvement in the Lysholm functional scale, likely not clinically meaningful, favoring the ALL group and an increased duration of post-operative lateral pain in the LET group.