Poster 219: ACL Reconstruction with LET Reduces Risk for Revision ACL Reconstruction in a Cross-Sectional Cohort

Abstract

Objectives:

The purpose of this study is to analyze a large cross-sectional sample of patients from an administrative database for trends in the yearly utilization of either isolated anterior cruciate ligament (ACL) reconstruction or concomitant ACL reconstruction with lateral extraarticular tenodesis (LET) for the treatment of ACL injury, and to compare the incidence of 5-year secondary events and 90-day emergency visits for each treatment modality.

Methods:

International Classification of Diseases (ICD), Tenth Revision and Current Procedural Terminology (CPT) codes were used to query the PearlDiver^TM database between October 2015 to October 2022 to identify patients with a diagnosis of ACL injury undergoing either isolated ACL reconstruction or ACL reconstruction with concomitant LET. Propensity score matching was performed to create two equally-sized cohorts with similar demographic characteristics. Kaplan-Meier survival analysis was used to estimate 5-year incidence of revision ACL reconstruction, meniscus debridement/repair, adhesion lysis, knee joint manipulation, and total knee arthroplasty for each group. Subsequent Cox Proportional Hazards Regression (CPHR) analysis provided statistical comparisons between treatment groups.

Results:

Between October 2015 to October 2022, there were 1022 patients that underwent ACL reconstruction concomitantly with LET, and 64,504 patients who underwent isolated ACL reconstruction for a diagnosis of ACL injury. Patient counts for concomitant ACL/LET procedures increased year after year. Kaplan-Meier analysis of revision ACL reconstruction in propensity-matched groups showed a 5-year incidence of 2.6% for patients undergoing ACL reconstruction with LET and 4.9% for ACL reconstruction alone, and CPHR analysis confirmed that the former patient group was significantly less likely to require revision [HR = 0.37 (95% CI 0.18-0.74), p = 0.005]. There were no significant differences between treatment modalities for any other secondary event.

Conclusions:

ACL reconstruction with LET is increasingly utilized to treat patients with ACL tears and demonstrate decreased risk for revision ACL reconstruction compared to patients treated with isolated ACL reconstruction.