Results of Anterior Cruciate Ligament Reconstruction with and without Lateral Extra-Articular Tenodesis between High Demand Patients: Randomized Controlled Trial

Abstract

Abstract Background Rupture of the anterior cruciate ligament (ACL) is a serious and common injury among recreational sport players and high demand patients as manual workers. One of the causes of recurrent graft failure and need to revision surgery is persistent anterolateral instability following traditional ACLR surgery. Patients and Method This is a prospective, randomized clinical trial comparing the failure rate of an arthroscopic anatomical single-bundle ACLR with or without LET performed using Lemaire technique in a comparable patient population of high demand patient with isolated ACL tear. Patients 40 years or younger with an ACL-deficient knee were included and also had to meet the following 3 criteria: (1) high demand patients (athlete, manual worker,…), (2) isolated ACL tear, (3) and grade 2 pivot shift or greater. The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Patients were reviewed at 3, 6 and 12months postoperatively. Results From December 2020 till December 2022, 41 patients were included in our study. The patients randomized in two groups. Group A included 20 patients who underwent arthroscopic anatomical single bundle ACLR combined with LET by modified Lemaire technique. Group B included 21 patients underwent anatomical single bundle ACLR only. There were 2 patients lost during follow up excluded from statistical analysis in group B. So, in total 20 patients in group A and 19 patients in group B were available for follow for 12 months. In comparison between both groups regarding rotatory laxity assessed by Pivot shift test, all patients in group A (20/20) showed negative pivot shift tests, while (18/19) patients in group B (94.74%) showed negative pivot shift. Only one patient (1/19, 5.26%) (failed case) examination showed grade 2 pivot shift test. Regarding antero-posterior laxity measured by KT1000, there are statistically insignificant differences in favor to group A than group B during follow up at 3,6,9,12 months. However, Patients included in group A showed statistically significant improvement of side-to-side KT1000 difference at 12 months follow than patients included in group B (P = 0.002). Regarding failure rate, no failed cases included in group A. while, there was only one case (1/19) failed in group B (5.26% failure rate) with no statistically significant difference between the 2 groups. Conclusion The addition of the modified Lemaire LAET technique to anatomical single bundle ACLR showed statistically significant improvement in side-to-side anteroposterior laxity measure by KT1000 Lachmeter. While there is no statistically significant reduction in the failure rate between combined and isolated ACLR.