Abstract
Objectives:
Prior literature has shown female soccer athletes are at a higher risk for anterior cruciate ligament (ACL) rupture. This risk persists even after primary ACL reconstruction (ACLR), given increased graft failure rates seen in this population. Thus, augmentation strategies such as lateral extra-articular tenodesis (LET) have gained increasing attention, but there is limited data in high-risk female soccer. The primary outcome of this study was to compare the graft failure rates and patient outcomes of ACLR with LET augmentation compared to isolated ACLR in female soccer players.
Methods:
A cohort of female soccer athletes who underwent ACLR was retrospectively analyzed. Participants were divided into two groups: those who received ACLR alone (control) and those who received ACLR with LET. Exclusion criteria included patients who were not involved in competitive soccer at the time of surgery or had less than 2-years follow-up. Patient demographics and physical exam findings, including the pivot shift results, were collected. Patient outcomes included graft failure, International Knee Documentation Committee (IKDC) and Lysholm scores, return to sport rates, and complications. Independent t-tests and chi-squared tests were conducted to compare outcomes between the two groups.
Results:
A total of 133 female soccer players who underwent ACLR and met inclusion criteria were identified, with 43 patients receiving LET and 90 patients undergoing sole ACLR. The LET cohort had a higher mean Beighton score (3.0 vs. 1.5; P<0.001) and greater proportion of generalized ligamentous laxity (48.8% vs. 18.9%; P<0.001). There were no significant differences between the two cohorts in age, level of competition, type of graft used, or meniscal intervention (P>0.05). Average follow-up was 39.0 and 36.1 months in the LET group and the control group, respectively. Final postoperative IKDC scores were greater in patients who received LET compared to those who did not (91.3 vs. 88.3; P=0.012). Further, there was a lower rate of graft failure, indicated by a confirmed ACL re-tear or a positive post-operative pivot shift, in patients who underwent LET compared to the control group (14% vs. 31.1%; P=0.036). The presence of positive post-operative pivot shift was also lower in the LET group compared to the control (9.3% vs. 27.8%; P=0.023). There were no significant differences in the rates of complications between the two groups (P>0.05), except for 9.3% of the LET patients developing a hematoma at the LET site.
Conclusions:
LET augmentation in ACLR is associated with a reduced graft failure rate and decreased post-operative rotational instability in female soccer athletes regardless of graft type used. This augmentation strategy may enhance the stability of the knee joint and help improve clinical outcomes, suggesting its potential as a standard adjunctive procedure for female soccer players undergoing primary ACLR.
