Summary
The association of Lateral Extrarticular Tenodesis to ACL reconstruction seems not to increase the risk of joint degeneration in valgus knee
Abstract
Objective
To assess whether performing lateral extraarticular tenodesis (LET) combined to hamstring ACL reconstruction in patients with preoperative genu valgum can increase joint degeneration at lateral compartment at 5-year postoperative follow-up.
Method
A multicenter match-pair study was conducted to compare homogeneous groups of skeletally mature patients with genu valgum who underwent primary isolated hamstring ACL reconstruction (Group 1) or in combination with modified Lemaire anterolateral extra-articular tenodesis (Group 2). All patients who underwent surgery at six different hospitals between 2016 and 2019 and in whom hamstrings were used as a graft were included. Excluding criteria were: history of contralateral knee surgery, poor quality of the x-ray, the presence of OA at preoperative X-ray, multiligamentous injuries, the presence of chondral injuries at the time of surgery, surgically treated lateral meniscus injuries, and ACL re-tear during postoperative follow-up. Genu valgum was defined as a hip-knee-ankle angle > 193° in preoperative telemetry. A propensity match score was performed using the following parameters: medial meniscal lesions, age at the time of surgery, gender, graft diameter, BMI, preoperative Tegner score, time between injury and surgery, degree of preoperative instability measured with KT1000 and Pivot Shift grade. The included patients were radiologically assessed preoperatively and at a 5-year follow-up using long leg standing x-ray, a Rosemberg view, a skyline view and a weight-bearing lateral view. Two independent observers evaluated the x-ray checking for increased joint collapse using the surface fit method, appearance of osteophytes, or increased degree of valgus.
Results
at the end of the matching thirty-five patients were included in group 1 and thirty-nine in group 2. All these patients were radiologically analyzed. In group 1, two patients showed increased valgus on telemetry (2° and 3°, respectively), 3 patients showed increased joint space narrowing, and no osteophytes were detected. In Group 2, one patient had increased valgus on telemetry (2 degrees), one patient had increased joint collapse, and no osteophytes were detected. There were no significant differences between the groups.
Conclusions
adding a LET to ACL reconstruction with hamstrings did not result in radiological degenerative changes in patients with genu valgum at 5-year follow-up.