Abstract
Objectives:
Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) and Lateral Extra-Articular Procedures (LEAP) over isolated ACL reconstruction (ACLR), in terms of reducing graft rupture and reoperation rate. However, most of the published studies included young patients, and there are no studies focusing on population over 30 years old. The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at mid-term follow-up in patients over the age of 30 years old. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture.
Methods:
Patients older than 30 years old who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched in a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was achieved to determine whether patients had experienced any complications or reoperations. Graft survivorship was assessed using Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model.
Results:
Two groups of 551 patients were included in the study with a mean follow-up of 97.19 ± 47.23 months. The mean age for both groups was 37 ± 6.14. The LEAP group was composed by 516 (93.6%) anterolateral ligament and 35 (6.4%) Lemaire. Overall, 19 (1.7%) patients had graft failure, 15 (2.7%) in the No LEAP group and 4 (0.7%) in the LEAP group (P = .0116). The risk of graft failure was significatively associated with the absence of LEAP (hazard ratio [HR], 3.309 [1.088; 10.065], P = 0.0350) and age between 30 to 35 years old (HR 4.533 [1.484; 13.841] P = .0080). A higher rate of reoperation for secondary meniscectomy were founded in the No LEAP group (5.6% vs 2.2%; P = .0031).
Conclusions:
Patients over 30 years old who underwent combined ACLR and LEAP experienced > 3-fold lower risk of ACL graft failure compared to isolated ACLR. Furthermore, the group without LEAP also experienced a higher rate of reoperation for secondary meniscectomy.