Summary
Adding a LEAT to a Hamstring and BPB ACLR reduces the failure rate
Abstract
Introduction
The addition of a lateral extra-articular procedure (LEAP) in primary anterior cruciate ligament reconstruction (ACLR) has increased to address rotational instability. Orthopaedic registries have made significant contributions to the improvement of patient outcomes through their ability to detect inferior results associated with specific surgical techniques. The aim of this study was to present the early results of combined ACL reconstruction with a LEAP from the New Zealand ACL Registry.
Methods
Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACLR performed between May 2014 and June 2022 were included, allowing for a minimum follow-up of 1-year. Procedures using bone-patellar tendon-bone (BTB), quads tendon or hamstring tendon autografts were analyzed. The primary outcome was revision ACLR. The revision rate was also analyzed in patients 16-25 and 26 and older. Secondary outcomes included the Marx activity score and the Knee Injury Osteoarthritis Outcome Score (KOOS). Analysis was stratified by graft type and compared between isolated ACLR (iACLR) versus ACLR with a LEAP (ACLR+LEAP). Statistical analysis was performed through a Chi-square test for binary outcomes and Mann-Whitney U test for continuous outcomes.
Results
A total of 20329 primary ACLR were analyzed in which 1263 had a LEAP.
In the BTB cohort (n = 6442), 5812 underwent ACLR and 630 underwent ACLR+LEAP. There were 3 revisions in the ACLR+LEAP patients with a BTB autograft (0.4%), compared to 630 revisions in patients who underwent BPB graft only ACLR (2.4%, p = 0.038).
In the hamstring cohort (n = 12776), 12231underwent iACLR and 545 underwent ACLR+LEAP. Four patients with ACLR+LEAP with a hamstring tendon autograft underwent a revision (0.7%) compared to 541 patients with a hamstring tendon autograft (4.8%, p = 0.020).
In the quads tendon cohort (n = 1111), 1023 underwent iACLR and 88 underwent ACLR+LEAP. One patient with an ACLR+LEAP underwent a revision (1.1%) compared to 19 patients with a quads tendon autograft (1.9%, p = 0.845).
With all grafts + LEAP patients over 25 had no failures. Patients aged 16-25 with a LEAP had a lower failure rate with all graft types (Fig 1)
In the BTB quads and hamstring cohorts, similar Marx activity (p>0.05),and KOOS scores (p>0.05), were reported at 2-year follow-up when comparing ACLR and ACLR+LEAP.
Discussion And Conclusion
Early data demonstrates a lower revision rate when ACLR using either BTB, or hamstring autograft is combined with a LEAP. The quad graft analysis has too few patients. Patients aged 16-25 showed a greater difference in the failure rate. Similar PROM scores were reported at 2-year follow-up between iACLR and ACLR+LEAP.
A further analysis will be performed just prior to the ACLSG meeting in Brazil