Summary
ACL Over-The-Top with LET provides higher Tegner scores and no increased incidence of lateral osteoarthritis at 20 years of follow-up. BTB ACL-R was associated with patello-femoral osteoarthritis.
Abstract
Background
Modern lateral extra-articular tenodesis (LET) has shown promising results at short term follow-up but there is a lack of studies investigating the incidence of complication and lateral oateoarthritis (OA) at long-term. The aim of the study was to compare in terms of failure rates, clinical outcomes and OA incidence three different ACL reconstruction techniques including hamstring single-bundle (HS group), patellar tendon (BTB) and hamstring over-the-top with LET (LET group).
Study design: Prospective randomized clinical trial; level of evidence II.
Methods
75 patients were randomized to receive one of the three ACL reconstruction techniques. At the last follow-up, patients reported outcomes (PROMs), complication and reoperation were collected for every patient.
An objective clinical evaluation was performed including anteroposterior laxity measurement (KT-1000) and pivot shift quantification (PS, triaxial-accellerometer).
Clinical failure were considered patients with evidence of graft rupture or those with KT-1000 side-to-side > 5mm or with PS side-to-side > >1mm/s2.
A radiographic evaluation was performed to assess the incidence of tibiofemoral and patellar OA.
Results
Final analysis was conducted on 61 patients (81.3%) at an average 23.0 ± 1.1 years follow-up, 38 patients completed the clinical and radiological evaluation. The LET group showed a higher Tegner score compared to the BTB (p=0.026), mean of 4.41 (up to 7) against 3.47 (up to 5).
No difference was identified in the other clinical scores among the three groups (p>0.05).
Revision rate and clinical failure were respectively 15.8% and 57.1% for the BTB group, 4.6% and 38.5% for the HS group and 4.6% and 18.8% for the LET group (P= 0.09 to 0.8, ns).
No difference in the quantitative evaluation of the Pivot Shift were reported, while AP side-to-side difference was lower in the BTB group compared to the HS group (mean -0.1mm vs. +1.5mm).
Finally, the BTB group showed a higher rate of patellofemoral OA compared to the other two groups (p=0,009) while the incidence of lateral OA was not increased in the LET group compared to the other techniques (p=0.50).
Conclusion
Satisfactory clinical outcomes after ACL reconstruction at long-term follow-up could be achieved with different modern surgical techniques. However, the BTB graft was associated with increased incidence of patellofemoral OA when compared with the other techniques.
Finally, LET was associated with increased sport partecipation and similar rate of lateral OA compared to others techniques at long-term follow-up.