Clinical outcomes of extra-articular tenodesis/anterolateral reconstruction in the ACL injured knee

Sonnery-Cottet, B., Barbosa, N.C., Vieira, T.D. and Saithna, A. ORCID: 0000-0002-2408-5307, 2018. Clinical outcomes of extra-articular tenodesis/anterolateral reconstruction in the ACL injured knee. Knee Surgery, Sports Traumatology, Arthroscopy, 26 (2), pp. 596-604. ISSN 0942-2056

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Abstract

Purpose: The role of concomitant extra-articular procedures in improving the outcome of ACL reconstruction has experienced a recent resurgence in interest. The aim of this article is to highlight the differences in philosophies and outcomes of historical non-anatomic reconstructions and contemporary, anatomical anterolateral reconstruction.

Methods: A narrative review was performed using PubMed/MEDLINE using the keywords "lateral extra-articular tenodesis" and "anterolateral ligament reconstruction".

Results: Results of search strategy: 37 studies [13 reporting clinical outcomes of isolated lateral extra-articular tenodesis (LET) in ACL deficient knees and 23 comparing isolated anterior cruciate ligament reconstruction (ACLR) with ACLR + LET] and one study on anterolateral ligament (ALL) reconstruction were identified as relevant and included in the review. Results of literature review: Isolated extra-articular reconstructions are rarely performed in contemporary practice. They are associated with a high rate of persistent anterior instability and early degenerative change. Combined ACL reconstruction and lateral extra-articular tenodeses results in a significant reduction in the prevalence of residual pivot shift, but the majority of the studies do not demonstrate any significant difference with respect to patient-reported outcome measures and return to sport. Although several authors report a trend towards decreased graft rupture rates, significant differences were not demonstrated in most studies. In a single clinical study, combined anatomic ACL and anterolateral ligament reconstruction was reported to be associated with a three-fold reduction in graft rupture rates and improved return to sport compared to isolated ACL graft choices.

Conclusions: Historically performed, combined ACL reconstruction and lateral extra-articular tenodeses are associated with improved knee kinematics. Although a trend towards decreased graft rupture rates is reported by several authors, the majority did not demonstrate a significant difference, likely as a result of small and underpowered studies using postoperative immobilisation and delayed rehabilitation protocols. More recently, combined ACLR and ALL reconstruction has been shown to be associated with significant improvements in graft failure and return to sport rates when compared to isolated ACLR. However, these results are from a single clinical series with only medium-term follow-up.

Level of evidence: IV.

Item Type: Journal article
Publication Title: Knee Surgery, Sports Traumatology, Arthroscopy
Creators: Sonnery-Cottet, B., Barbosa, N.C., Vieira, T.D. and Saithna, A.
Publisher: Springer
Date: February 2018
Volume: 26
Number: 2
ISSN: 0942-2056
Identifiers:
NumberType
10.1007/s00167-017-4596-5DOI
4596Publisher Item Identifier
Rights: © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017.
Divisions: Schools > School of Science and Technology
Depositing User: Linda Sullivan
Date Added: 01 Nov 2018 12:56
Last Modified: 01 Nov 2018 12:56
URI: http://irep.ntu.ac.uk/id/eprint/34839

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