Les patients pédiatriques et adolescents présentent des taux de re-rupture du LCA significativement plus bas lorsque la reconstruction du LCA est associée à une ténodèse extra-articulaire latérale

Abstract

The purpose of this study was to compare the clinical outcomes of isolated ACLR versus combined ACLR + lateral extraarticular tenodesis (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. A retrospective analysis of consecutive pediatric and adolescent patients who underwent ACLR with or without the Arnold–Coker modification of the MacIntosh procedure was conducted. Clinical outcomes including graft-rupture rates, patient reported outcome measures (KOOS and subjective IKDC), knee stability, return to sport rates, re-operation rates and complications were assessed. Comparisons between variables were assessed with Chi 2 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. In total, 111 patients with a mean follow-up of 43.8 ± 17.6 (range: 24–89 months) were included in the study. Forty 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 = 15.91; 95% CI = 1.81–139.44; P = .012), it was also associated with significantly better knee stability (rate of grade 3 pivot shift, 0% ACLR + LET, 11% ACLR, P = .021; side-to-side AP laxity difference > 5 mm 0% ACLR + LET, 17.2%, P = .003) and Tegner activity level (isolated ACLR, 6; ACLR + LET 7 P = .01). There were no significant differences exceeding known minimal clinically important difference (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. Combined ACLR + LET is associated with significant advantages over isolated ACLR in pediatric and adolescent patients. These advantages include a significant reduction in graft rupture rates and better knee stability with no increase in the rate of non-graft rupture related re-operations or complications.