Abstract
Objectives
The addition of a lateral extraarticular procedure (LEAP) to both primary and revision ACL reconstruction (ACLR) has become increasingly common in recent years. Recent reports have suggested that the rates of surgery for range of motion (ROM) complications are higher with the addition of a LEAP and particularly when using a quadriceps tendon (QT) graft. The aim of this retrospective study was to further explore the rates of reoperation for ROM problems in the setting of the addition of a LEAP to an ACL reconstruction with either a hamstring tendon (HS) or QT autograft.
Methods
In a single surgeon series, 672 patients underwent a primary ACLR with either a HS or QT autograft between 1 January 2021 and 31 August 2023. 205 had an additional LEAP using a modified Ellison technique. Two year rates of reoperation for ROM problems and graft rupture rates were compared between those patients who had LEAP and those who did not, and then by graft type and sex.
Results
633 (94 %) patients were followed up out to 2 years. 20/193 (10.4%) patients who had a LEAP required further surgery for a ROM complication (predominantly resection of symptomatic Cyclops lesions) compared to 13/440 (3.0%) patients who did not have a LEAP (p<0.001), Risk Ratio (RR)=3.5, 95%CI 1.8-6.9. 14/65 (21.5%) patients who had a LEAP in combination with a QT graft required further surgery for a ROM complication compared to 6/122 (4.9%) patients who had a LEAP in combination with a HS graft (p<=0.001). A LEAP in combination with a QT graft had 4.6 times the risk (RR=4.6, 95%CI 1.9-11) of requiring further surgery for ROM issues compared to a LEAP in combination with a HS graft.
When subgrouping by sex, 13/53 (24.5%) of male patients who had a LEAP in combination with a QT graft required further surgery for a ROM complication compared to 3/62 (4.8%) male patients who had a LEAP in combination with a HS graft (p=0.002, RR=5.1). While a similar trend was seen in female patients [QT+LEAP 1/12 (8.3%) vs. HS+LEAP 3/66 (4.5%)], the numbers were too small for statistical analysis.
Graft rupture rates were similar between patients who did not have a LEAP (13/440: 3%) and patients who had a LEAP (8193: 4.1%), p=0.5.
Conclusions
The addition of a LEAP to a primary ACLR was associated with an increased risk of re-operation for ROM issues, particularly with QT grafts. It is unclear whether this was related to the use of the modified Ellison procedure as opposed to other LEAP techniques. Caution should be used when extrapolating the findings of the use of a LEAP in combination with a HS graft to other graft types.