Poster 214: Primary Anterior Cruciate Ligament Reconstruction: Bone-Patellar Tendon-Bone Graft with Modified Lemaire Tenodesis Versus Hamstring Graft with Anterolateral Ligament Reconstruction – A Clinical Comparative Matched-Pair Analysis from the SANTI Study Group

Abstract

Objectives:

The purpose of this study was to evaluate the reoperation rates between primary ACL reconstructions done using a BPTB autograft combined with modified Lemaire tenodesis versus a hamstring tendon (HT) autograft combined with anterolateral ligament reconstruction (ALLR). It was hypothesized that the combination of HT + ALLR would result in lower reoperation rates.

Methods:

Patients undergoing primary reconstruction with BPTB + Lemaire between January 2003 to December 2021 were propensity matched in a 1:4 ratio to patients who underwent HT + ALLR during the same period. Reoperation rates and clinical outcomes were compared. Reoperations (i.e cyclops lesion, arthrolysis, secondary meniscal surgeries, infections, and graft failures) were identified by review of medical records and final patient interviews.

Results:

The study included 365 patients: 73 in the BPTB + Lemaire group and 292 in the HT + ALLR group. The mean follow-up was 91.8 ± 56.0 months. The HT + ALLR group had a significantly lower reoperation rate than the BPTB + Lemaire group (10.6% vs. 24.7%, P < .0001) with a lower graft rupture rate (3.4% vs. 5.5%; P = 0.22). The BPTB + Lemaire group had a more than 2.5 times increased risk of reoperation (hazard ratio [HR], 2.57 [1.15; 5.74], P = 0.0209). Kaplan-Meier analysis confirmed superior reoperation-free survivorship in the HT + ALLR group.

Conclusions:

Primary ACL reconstruction using combined BPTB + Lemaire resulted in significantly higher reoperation rates (more than 2.5 times more likely) when compared to HT + ALLR.