Additional lateral extra-articular tenodesis in revision ACL reconstruction does not influence the outcome of patients with low-grade anterior knee laxity

T. C. Drenck,Lena Eggeling,J. Frings,M. Krause,Alexander Korthaus,Karl-Heinz Frosch,Anna Krukenberg,Ralph Akoto

doi:10.1007/s00402-021-04145-y

Abstract

IntroductionThere is limited evidence on the indications of lateral extra-articular tenodesis (LET) in revision ACLR. The aim of this study was to evaluate the influence of the LET in patients with revision ACLR with preoperative low-grade anterior knee laxity.MethodsBetween 2013 and 2018, 78 patients who underwent revision ACLR with preoperative low-grade anterior knee laxity [≤ 5 mm side-to-side difference (SSD)] were included in the retrospective cohort study. An additional modified Lemaire tenodesis was performed in 23 patients during revision ACLR and patients were clinically examined with a minimum of 2 years after revision surgery. Postoperative failure of the revision ACLR was defined as SSD in Rolimeter® testing ≥ 5 mm or pivot-shift grade 2/3.ResultsIn total, failure of the revision ACLR occurred in 11.5% (n = 9) of the cases at a mean follow-up of 28.7 ± 8.8 (24–67) months. Patients with an additional LET and revision ACLR did not show a significantly reduced failure rate (13% vs. 11%) or an improved clinical outcome according to the postoperative functional scores or pain in regards to patients with an isolated revision ACLR (Tegner 5.7 ± 1.3 vs. 5.9 ± 1.5, n.s.; IKDC 77.5 ± 16.2 vs. 80.1 ± 14.9, n.s., Lysholm 81.9 ± 14.2 vs. 83.8 ± 14.5, n.s.; VAS 1.9 ± 2.2 vs. 1.2 ± 1.7, n.s.).ConclusionsAn additional LET in patients with revision ACLR with low-grade anterior knee laxity does not influence patient-related outcomes or failure rates. Subjects with preoperative low-grade anterior knee laxity may not benefit from a LET in revision ACLR.Level of evidenceIII

Highlights

There is limited evidence on the indications of lateral extra-articular tenodesis (LET) in revision anterior cruciate ligament reconstruction (ACLR)
Redler et al have shown that a combined revision ACLR with a doubled gracilis and semitendinosus autograft and LET in 118 patients led to a significant clinical improvement with a mean follow-up of 10.6 years [8], while Ferretti et al demonstrated good to very good results with combined LET and revision ACLR [28]
This study indicates that patients with revision ACLR without preoperative high-grade knee laxity, likely without a lesion of the anterolateral structures, may not benefit from an additional LET during revision surgery

Summary

Introduction

There is limited evidence on the indications of lateral extra-articular tenodesis (LET) in revision ACLR. The aim of this study was to evaluate the influence of the LET in patients with revision ACLR with preoperative low-grade anterior knee laxity. Conclusions An additional LET in patients with revision ACLR with low-grade anterior knee laxity does not influence patient-related outcomes or failure rates. Authors have revealed that combined revision anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular tenodesis (LET) improve clinical and radiological outcomes [8, 9]. A previous study showed a significantly lower failure rate with an additional LET for revision ACLR and high-grade knee laxity (side-to-side difference ≥ 6 mm, pivot-shift grade 3) [15]. To the best of our knowledge, the effect of a LET in patients with low-grade anterior knee laxity (side-toside difference ≤ 5 mm, pivot-shift grade 1–2) and revision ACLR has not been examined before

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