Lateral extra-articular tenodesis protects high-risk patients from the risk of re-rupture and improves patient-reported outcomes after primary anterior cruciate ligament repair: A retrospective cohort study with ≥2-year follow up.

Abstract

Primary repair of proximal anterior cruciate ligament (ACL) tears is appealing, but the risk of re-rupture is a concern, particularly in young athletes. This study aimed to assess whether adding a lateral extra-articular tenodesis (LET) to an ACL repair procedure reduces the risk of failure and improves patient-reported outcomes in high-risk patients. A retrospective cohort of 39 consecutive patients treated within 14 days of injury (2018-2023) was reviewed. Nineteen patients underwent isolated ACL repair, while 20 patients received a combined repair plus a Coker-Arnold LET. The minimum follow up period was 24 months (mean ± standard deviation: 42.5 ± 11.8). Failure rates, return to sport, Rolimeter side-to-side laxity, and patient-reported outcome measures were compared. Failure rates were similar between the two groups (15.8 % vs. 10.0 %; P = 0.589), as well as for anterior laxity, IKDC and ACL-Return to Sport after Injury scores (P > 0.05). Despite being younger, patients who underwent combined procedures achieved higher postoperative activity and better patient-reported outcomes: KOOS-Function: 94.6 vs. 86.1 (P = 0.007); KOOS-Sport: 83.5 vs. 70.8 (P = 0.020); KOOS-Total: 89.5 vs. 79.0 (P = 0.010); and FJS-12: 83.3 vs. 67.5 (P = 0.008). Return to sport was 74 % in the isolated ACL repair group and 85 % in the combined procedures group (P = 0.382). The addition of a lateral extra-articular procedure to primary ACL repair in patients at a higher risk of re-rupture results in failure rates comparable to those of lower-risk, less active individuals and enhances functional recovery and activity levels.