Abstract
Objectives:
Anterior cruciate ligament (ACL) reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, a modified Lemaire extra-articular tenodesis (LET) has been added to the procedure, which has been shown to decrease failure rates. However, not much is currently known about the short-term rehabilitation following this procedure. Therefore, the goal was to assess the short-term patient-reported outcomes (PROMS), strength-testing and functional testing following ACLR with and without LET.
Methods:
A prospective study was performed for all patients undergoing ACL reconstruction in a regional teaching hospital from 2019 to 2022, in which LET was added in 2020. All patients underwent standard four- or five-strand autologous hamstring ACL reconstruction using femoral button fixation and tibial screw fixation and one group underwent additional LET with anchor fixation.
Preoperatively, patients completed patient-reported outcome measures (PROMs; International Knee Documentation Committee questionnaire, Lysholm, Numeric Rating Scale questionnaires for pain, EQ5D), Biodex testing for flexion and extension strength at 60 and 180 peak torque, and range of motion. These outcomes were also obtained at 3, 6, 9 and 12 months postoperatively and single-leg and timed-6m-hop tests were performed at 6 and 9 months postoperatively.
Results:
One-hundred-sixty-seven patients were prospectively enrolled of which 61 (36.5%) received additional LET. Patients preoperatively had similar age, gender, Body Mass Index (BMI), meniscus and chondral damage, collateral ligament injury, PROMs or Biodex, except thicker grafts in the LET group (9.0 vs 8.7 mm, p=0.009). At three months, Lemaire patients reported less pain (NRS 16.2 vs. 35.6, p<0.001) and better Lysholm score (78.4 vs. 70.8, p=0.039) compared to the isolated ACLR group. At six months, Lemaire patients had better LSI for 6m hop tests (115% vs 105%, p=0.011). At 12 months, the Lemaire group reported higher Tegner score (7.3 vs 6.2, p=0.062), and more patients returned to their preinjury Tegner level compared to isolated ACLR (80% vs. 51%, p=0.032).
Conclusions:
This prospective comparative study noted that patients undergoing ACLR with LET had less pain and better Lysholm scores at 3 months, and better LSI for 6m hop tests at 6 months follow-up. Furthermore, patients with additional LET had a higher postoperative Tegner activity level and a higher percentage of patients reaching pre-injury level of sports at 1-year follow-up.
