Low graft failure and favourable outcomes after anterior cruciate ligament reconstruction and lateral extra-articular tenodesis in young athletes.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 41255740.
- Also identified by DOI 10.1002/jeo2.70524 and PMC identifier 12620560.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Young athletes undergoing anterior cruciate ligament reconstruction (ACLR) are at high risk of graft failure and contralateral anterior cruciate ligament (CACL) injury, despite advances in surgical technique. Lateral extra-articular tenodesis (LET) has emerged as a potential adjunct to improve graft survivability in high-risk young populations. The study aimed to describe graft survival, CACL rates, patient-reported outcome measures (PROMs) and return-to-sport (RTS) outcomes in high-risk under-20 athletes undergoing ACLR and LET. This retrospective cohort study analysed U20 athletes who underwent primary ACLR with hamstring tendon autografts and concurrent LET between 2017 and 2023. All surgeries were performed by a single surgeon using a standardized technique. Outcomes included graft survivability, CACL injury incidence, and RTS level, with functional recovery assessed via the Marx Activity Scale and Tegner-Lysholm Score. Kaplan-Meier survival analysis, independent <i>t</i>-tests, <i>χ</i> <sup>2</sup> tests, and multivariate logistic regression were used to evaluate outcomes and identify predictors, with significance set at <i>p</i> < 0.05. One hundred fifty-nine patients (mean age 17.6 ± 1.9 years) were included, with a mean follow-up of 49.7 ± 18.8 months. Graft rerupture occurred in 2.5% of patients, all within 40 months postoperatively. CACL injury was observed in 12.6% of patients. Over 60% of athletes returned to their pre-injury level of sport, with higher PROMs in those achieving same-level RTS. A smaller graft diameter was significantly associated with increased risk of CACL injury (<i>p</i> < 0.05). LET was not associated with adverse effects on functional recovery. This cohort showed low graft rerupture rates, favourable functional outcomes and encouraging RTS levels following ACLR and LET. However, CACL injury remained a substantial concern. LET may be considered in adolescent athletes participating in pivoting sports to potentially reduce graft failure, although further comparative studies are needed. Level IV.