Lateral extra-articular tenodesis reduces graft failure without affecting functional outcomes after revision anterior cruciate ligament reconstruction: A retrospective comparative study with 6-year follow-up

IF 3.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2026-02-01 Epub Date: 2025-11-29 DOI:10.1016/j.jisako.2025.101048

Waldo Gonzalez , Jorge Isla , Alfredo Sandoval , Francisco Figueroa , Minerva Itriago , David Figueroa

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引用次数: 0

Abstract

Introduction

Revision anterior cruciate ligament reconstruction (ACLR) is associated with a substantially higher risk of anterior cruciate ligament (ACL) graft failure than primary ACLR. Lateral extra-articular tenodesis (LET) has gained increasing attention as an adjunctive procedure to enhance rotatory stability and potentially reduce the rate of ACL graft failure. The purpose of this study was to compare clinical and functional outcomes between patients undergoing isolated revision ACLR and those undergoing revision ACLR with concomitant LET. We hypothesized that the addition of LET would reduce the incidence of ACL graft failure without compromising functional outcomes or return-to-sport rates.

Methods

This retrospective cohort study included skeletally mature patients who underwent first-time revision ACLR with a minimum follow-up of four years. Patients were divided into two groups according to surgical technique: isolated revision ACLR (n = 58) and revision ACLR with LET (n = 65). ACL graft failure was defined as clinically confirmed graft rupture based on a positive pivot-shift or Lachman test, magnetic resonance imaging, or the need for further revision ACLR. Demographic characteristics, surgical details, and patient-reported outcomes (International Knee Documentation Committee [IKDC] and Tegner activity scale) were compared between groups.

Results

A total of 123 patients were analyzed (mean age: 27.1 ± 8.0 years) with a mean follow-up of 6.0 years (range: 4.5–7.3 years). Functional outcomes were comparable between groups (IKDC score: 80.4 ± 9.2 vs 84.1 ± 8.8; p = 0.86; Tegner score: 6.6 ± 1.3 vs 6.7 ± 1.2; p = 0.92). ACL graft failure occurred in 11 patients (18.3%) in the isolated revision ACLR group and in 2 patients (3.3%) in the revision ACLR with LET group (p = 0.03; odds ratio: 0.15; 95% confidence interval: 0.03–0.72). Sixty percent of all patients (74/123) returned to sport, including 50 (40.6%) who reached their preinjury level, with no statistically significant differences between groups (p = 0.41).

Conclusion

The addition of an LET to revision ACLR significantly reduced the rate of ACL graft failure without adversely affecting functional recovery or return-to-sport rates. This procedure may serve as a valuable adjunct for selected high-risk patients undergoing revision ACLR.

Level of evidence

IV.

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外侧关节外肌腱固定术减少移植失败而不影响前交叉韧带重建翻修后的功能结果：一项6年随访的回顾性比较研究。

简介：与初次ACL重建（ACLR）相比，翻修前交叉韧带重建（ACL）与ACL移植失败的风险高得多。外侧关节外肌腱固定术（LET）作为一种增强旋转稳定性和潜在降低ACL移植失败率的辅助手术越来越受到关注。本研究的目的是比较单独翻修ACLR患者和翻修ACLR合并LET患者的临床和功能结果。我们假设添加LET可以在不影响功能结局或恢复运动率的情况下降低前交叉韧带移植失败的发生率。方法：这项回顾性队列研究包括首次行ACLR翻修的骨骼成熟患者，随访时间至少为4年。根据手术技术将患者分为单独ACLR翻修组（n = 58）和LET翻修ACLR翻修组（n = 65）。ACL移植失败被定义为基于Pivot-shift或Lachman试验阳性、磁共振成像或需要进一步翻修ACLR的临床证实的移植物破裂。人口统计学特征、手术细节和患者报告的结果（国际膝关节文献委员会[IKDC]和Tegner活动量表）在两组之间进行比较。结果：共分析123例患者，平均年龄27.1±8.0岁，平均随访6.0年（范围4.5-7.3年）。两组间功能结果具有可比性（IKDC, 80.4±9.2 v/s, 84.1±8.8;p = 0.86; Tegner, 6.6±1.3 v/s, 6.7±1.2;p = 0.92）。单独改良ACLR组有11例（18.3%）患者发生ACL移植失败，LET改良ACLR组有2例（3.3%）患者发生ACL移植失败（p = 0.03；优势比为0.15；95%可信区间为0.03-0.72）。所有患者中有60%（74/123）恢复了运动，其中50例（40.6%）恢复到损伤前水平，组间差异无统计学意义（p = 0.41）。结论：在改良ACLR中加入LET可显著降低ACL移植失败率，而不会对功能恢复或恢复运动率产生不利影响。该手术可作为一种有价值的辅助选择高危患者接受改良ACLR。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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