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 2 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 postoperative data were evaluated.
Results
The groups with (86 patients) and without (88 patients) an associated extra-articular
reconstruction had similar preoperative data. Group 2 had a lower failure rate (4.6%
vs 14.7%; P = .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.
Conclusions
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.
Level of Evidence
III, retrospective comparative therapeutic trial.
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References
- Does revision anterior cruciate ligament (ACL) reconstruction provide similar clinical outcomes to primary ACL reconstruction? A systematic review and meta-analysis.Orthop Surg. 2020; 12: 1534-1546
- Differences in strength, patient-reported outcomes, and return-to-play rates between athletes with primary versus revision acl reconstruction at 9 months after surgery.Orthop J Sport Med. 2020; 8
- Comparison of concomitant injuries and patient-reported outcome in patients that have undergone both primary and revision ACL reconstruction—a national registry study.J Orthop Surg Res. 2020; 15: 9
- Outcomes after arthroscopic revision surgery for anterior cruciate ligament injuries.Acta Orthop. 2021; 92: 443-447
- Clinical outcomes in revision anterior cruciate ligament reconstruction: A meta-analysis.Arthroscopy. 2018; 34: 289-300
- Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament-deficient knee.J Orthop Traumatol. 2017; 18: 91-106
- The anterolateral complex of the knee: Results from the International ALC Consensus Group Meeting.Knee Surg Sport Traumatol Arthrosc. 2019; 27: 166-176
- Revision ACL reconstruction: influence of a lateral tenodesis.Knee Surg Sport Traumatol Arthrosc. 2012; 20: 1565-1570
- Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.Am J Orthop (Belle Mead NJ). 2015; 44: 89-93
- Combined intra- and extra-articular technique in revision anterior cruciate ligament reconstruction.Joints. 2017; 5: 156-163
- Combined intra- and extra-articular grafting for revision ACL reconstruction: A multicentre study by the French Arthroscopy Society (SFA).Orthop Traumatol Surg Res. 2017; 103: S223-S229https://doi.org/10.1016/j.otsr.2017.08.007
- Revision anterior cruciate ligament reconstruction with hamstrings and extra-articular tenodesis: A mid- to long-term clinical and radiological study.Arthroscopy. 2018; 34: 3204-3213
- Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction.Am J Sport Med. 2019; 47: 324-333
- Functional outcomes following contralateral hamstring tendon autografts with extra-articular tenodesis for ACL revision surgery.J Sport Med Phys Fit. 2019; 59: 1897-1901
- Good mid-term outcomes and low rates of residual rotatory laxity, complications and failures after revision anterior cruciate ligament reconstruction (ACL) and lateral extra-articular tenodesis (LET).Knee Surg Sport Traumatol Arthrosc. 2020; 28: 418-431
- Slope-correction osteotomy with lateral extra-articular tenodesis and revision anterior cruciate ligament reconstruction is highly effective in treating high-grade anterior knee laxity.Am J Sports Med. 2020; 48: 3478-3485
- Lateral extra-articular tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior knee instability.Knee. 2020; 27: 1451-1457
- Additional lateral extra-articular tenodesis in revision ACL reconstruction does not influence the outcome of patients with low-grade anterior knee laxity.Arch Orthop Trauma Surg. 2022; 142: 291-299
- Revis ion anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft combined with modified lemaire technique versus hamstring graft combined with anterolateral ligament reconstruction: A clinical comparative matched study with a mean follow-up of 5 years from The SANTI Study Group.Am J Sports Med. 2022; 50: 395-403
- The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL reconstruction alone in patients undergoing ACL revision surgery.Orthop Traumatol Surg Res. 2021; 107: 102739
- Anterolater al ligament reconstruction improves anteroposterior stability as well as rotational stability in revision anterior cruciate ligament reconstruction with high-grade pivot shift.J Knee Surg. 2021; 34: 1310-1317
- Comparative clinical outcomes of anterolateral ligament reconstruction versus lateral extra-articular tenodesis in combination with anterior cruciate ligament reconstruction: Systematic review and meta-analysis.Arch Orthop Trauma Surg. 2020; 140: 923-931
- Anterolateral knee extra-articular stabilizers: A robotic study comparing anterolateral ligament reconstruction and modified lemaire lateral extra-articular tenodesis.Am J Sport Med. 2018; 46: 607-616
- Anterolateral ligament reconstruction and modified lemaire lateral extra-articular tenodesis similarly improve knee stability after anterior cruciate ligament reconstruction: A biomechanical study.Arthroscopy. 2020; 36: 1942-1950
- Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction.Am J Sport Med. 2017; 45: 347-354
- Lateral tenodesis procedures increase lateral compartment pressures more than anterolateral ligament reconstruction, when performed in combination with ACL reconstruction: A pilot biomechanical study.J ISAKOS. 2021; 6: 66-73
- Anterolateral tenodesis or anterolateral ligament complex reconstruction: Effect of flexion angle at graft fixation when combined with ACL reconstruction.Am J Sport Med. 2017; 45: 3089-3097
- Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction.J ISAKOS. 2021; 6: 74-81
- Dominant inheritance in familial generalised articular hypermobility.J Bone Joint Surg Br. 1970; 52: 145-147
- Classifications in Brief: Outerbridge Classification of Chondral Lesions.Clin Orthop Relat Res. 2018; 476: 2101-2104
- Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: Validity and reproducibility.Am J Sports Med. 2010; 38: 1894-1899
- Questionário específico para sintomas do joelho“ Lysholm Knee Scoring Scale”: tradução e validação para a língua portuguesa.Acta Ortopédica Brasileira. 2006; 14: 268-272
- Influence of preoperative tunnel widening on the outcomes of a single stage-only approach to every revision anterior cruciate ligament reconstruction: An analysis of 409 consecutive patients from the SANTI Study Group.Am J Sports Med. 2021; 49: 1431-1440
- Combined reconstruction of the anterolateral ligament in patients with anterior cruciate ligament injury and ligamentous hyperlaxity leads to better clinical stability and a lower failure rate than isolated anterior cruciate ligament reconstruction.Arthroscopy. 2019; 35: 2648-2654
- Surgical timing does not interfere on clinical outcomes in combined reconstruction of the anterior cruciate ligament and anterolateral ligament: A comparative study with minimum 2-year follow-up.Arthroscopy. 2021; 37: 1909-1917
- Combined anterior cruciate ligament and anterolateral ligament reconstruction.Arthrosc Tech. 2016; 5: e1253-e1259
- Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial.Am J Sport Med. 2020; 48: 285-297
- Research Pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.Arthroscopy. 2017; 33: 1102-1112
- Emerging trends in anterior cruciate ligament reconstruction.J Knee Surg. 2017; 30: 63-69
- New trends in anterior cruciate ligament reconstruction: A systematic review of national surveys of the last 5 years.Joints. 2018; 6: 177-187
- Allograft tendons are a safe and effective option for revision ACL reconstruction: A clinical review.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 1771-1781
- Allograft use results in higher re-revision rate for revision anterior cruciate ligament reconstruction.Orthop J Sports Med. 2018; 62325967118775381
- Effect of lateral extra-articular tenodesis on anterior cruciate ligament graft incorporation.Orthop J Sport Med. 2020; 8
- Clinical results of combined acl and anterolateral ligament reconstruction: A narrative review from the SANTI Study Group.J Knee Surg. 2021; 34: 962-970
- Combined anterolateral and anterior cruciate ligament reconstruction improves pivot shift compared with isolated anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials.Arthroscopy. 2021; 37: 2677-2703
- There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 3854-3863
- Anterior Cruciate ligament reconstruction alone versus with lateral extra-articular tenodesis with minimum 2-year follow-up: A meta-analysis and systematic review of randomized controlled trials.Am J Sport Med. 2022; 50: 1137-1145
- Single-stage revision anterior cruciate ligament reconstruction: experience with 91 patients (40 elite athletes) using an algorithm.Am J Sport Med. 2021; 49: 364-373
Article info
Publication history
Published online: July 12, 2022
Accepted:
June 26,
2022
Received:
December 23,
2021
Footnotes
See commentary on page 320
The authors report that they have no conflicts of interest in the authorship and publication of this article. ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
