The effect of lateral extra-articular tenodesis on in vivo cartilage contact in combined anterior cruciate ligament reconstruction.

Abstract

Lateral extra-articular tenodesis (LET) may confer improved rotational stability after anterior cruciate ligament reconstruction (ACLR). Little is known about how LET affects in vivo cartilage contact after ACLR. The aim of this study was to investigate the effect of LET in combination with ACLR (ACLR + LET) on in vivo cartilage contact kinematics compared to isolated ACLR (ACLR) during downhill running. It was hypothesised that cartilage contact area in the lateral compartment would be larger in ACLR + LET compared with ACLR, and that the anterior-posterior (A-P) position of the contact center on the lateral tibia would be more anterior after ACLR + LET than after ACLR. Twenty patients were randomly assigned into ACLR + LET or ACLR during surgery (ClinicalTrials.gov:NCT02913404). At 6months and 12months after surgery, participants were imaged during downhill running using biplane radiography. Tibiofemoral motion was tracked using a validated registration process. Patient-specific cartilage models, obtained from 3T MRI, were registered to track bone models and used to calculate the dynamic cartilage contact area and center of cartilage contact in both the medial and lateral tibiofemoral compartments, respectively. The side-to-side differences (SSD) were compared between groups using a Mann-Whitney U test. At 6months after surgery, the SSD in A-P cartilage contact center in ACLR + LET (3.9 ± 2.6mm, 4.4 ± 3.1mm) was larger than in ACLR (1.2 ± 1.6mm, 1.5 ± 2.0mm) at 10% and 20% of the gait cycle, respectively (p < 0.01, p < 0.05). There was no difference in the SSD in cartilage contact center at 12months after surgery. There was no difference in SSD of cartilage contact area in the medial and lateral compartments at both 6 and 12months after surgery. There were no adverse events during the trial. LET in combination with ACLR may affect the cartilage contact center during downhill running in the early post-operation phase, but this effect is lost in the longer term. This suggests that healing and neuromuscular adaptation occur over time and may also indicate a dampening of the effect of LET over time. (337 /350 words) LEVEL OF EVIDENCE: Level II.