Summary
Primary ACL reconstruction with BPTB + Lemaire results in significantly higher reoperation rates compared to HT + ALLR, with no significant differences in terms of graft failure rate.
Abstract
Background
The addition of lateral extra-articular procedures (LEAPs), has been shown to reduce graft rupture rates when added to hamstrings tendon (HT) autografts in ACL reconstruction, but there is limited literature reporting the clinical results of combining bone patellar tendon-bone (BPTB) autografts with LEAPs and comparing different LEAPs, such as the Modified Lemaire as lateral extra-articular tenodesis (LET) procedure versus anterolateral ligament reconstruction (ALLR).
Purpose/Hypothesis: To evaluate reoperation rates between primary ACL reconstructions using BPTB autograft combined with modified Lemaire LET and those using HT autograft combined with ALLR. We hypothesized that both procedures may provide similar graft rupture rate and reoperation rates.
Study design: Cohort study; level of evidence 3.
Methods
Patients who underwent primary ACL reconstruction with BPTB + Lemaire between January 2003 and December 2021 were propensity matched 1:4 with patients who underwent HT + ALLR during the same period. Failure rates, reoperation rates and clinical outcomes were compared. Multivariable analysis using the Cox model was performed to examine the relationship between graft rupture, reinterventions, surgical procedure type, and all potential explanatory variables.
Results
The study included 365 patients: 73 in the BPTB + Lemaire group and 292 in the HT + ALLR group, with a mean follow-up of 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). Graft rupture rates were not significantly different between the groups (3.4% in the HT + ALLR group vs. 5.5% in the BPTB + Lemaire group; P = .22). The BPTB + Lemaire group had a more than 2.5-fold increased risk of reoperation (hazard ratio [HR], 2.57 [1.15-5.74]; P = .0209). Kaplan-Meier analysis confirmed superior reoperation-free survival in the HT + ALLR group.
Conclusion
Primary ACL reconstruction with BPTB + Lemaire results in significantly higher reoperation rates compared to HT + ALLR, with no significant differences in terms of graft failure rate.