ACL reconstruction with lateral extra-articular tenodesis using a continuous graft: 10-year outcomes of 50 cases.

Autor: Meynard P; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France. Electronic address: pierre.meynard@live.com., Pelet H; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France., Angelliaume A; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France., Legallois Y; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France., Lavignac P; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France., De Bartolo R; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France., Fabre T; Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France., Costes S; Département d'orthopédie-traumatologie, hôpital Robert-Boulin, 112, rue de la Marne, 33500 Libourne, France.
Jazyk: angličtina
Zdroj: Orthopaedics & traumatology, surgery & research : OTSR [Orthop Traumatol Surg Res] 2020 Sep; Vol. 106 (5), pp. 929-935. Date of Electronic Publication: 2020 Jun 10.
DOI: 10.1016/j.otsr.2020.04.007
Abstrakt: Background: Persistence of pivot shift is the main problem after isolated intra-articular anterior cruciate ligament (ACL) reconstruction. Adding lateral extra-articular tenodesis (LET) to the ACL procedure increases the knee's stability by controlling rotational laxity. The aim of this study was to evaluate the long-term clinical and radiological outcomes of combined ACL reconstruction with LET using a continuous hamstring graft as a first-line procedure.
Material and Methods: Fifty patients were reviewed at 10 years postoperative. Subjective outcome scores -IKDC, Lysholm, KOOS and Tegner- were collected. A clinical and radiological assessment was done. The knees' anteroposterior laxity was measured with a rollimeter.
Results: The mean IKDC subjective score was 85.5, the mean Lysholm score was 90.2 and 80% of patients had a score graded as good or very good. No pivot shift was present in 94% of patients and there was a firm endpoint in the Lachman test in 86% of patients. There was a flexion deficit>5° in 5 patients and an extension deficit of 10° in one patient. Most patients (56%) had resumed their physical activities at the same level as before the surgery. Signs of osteoarthritis were found in 26% of patients (16% were Ahlback stage 1 and 10% were stage 2). There was only one graft failure. These good outcomes are consistent with other published studies on combined ACL-LET. There was neither significant stiffness, nor a higher rate of secondary osteoarthritis relative to ACL reconstruction only, particularly in the lateral tibiofemoral compartment.
Conclusion: Adding primary LET to ACL reconstruction improves control of rotational laxity over time without increasing the complication rate.
Level of Evidence: IV, retrospective study without control group.
(Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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