Anterior cruciate ligament reconstruction using peroneus longus with lateral extra-articular tenodesis has excellent functional outcomes with a high return to sport rate: A prospective cohort study of 482 patients over 2 years.

Abstract

As our understanding of anterolateral rotatory instability (ALRI) has improved, there has been a shift towards a combined procedure of anterior cruciate ligament (ACL) reconstruction and lateral extra-articular procedure (LEAP) to reduce ALRI and decrease graft re-rupture rates. The purpose of the present prospective cohort study was to assess the outcomes, return to sport and complication rate with lateral extra-articular tenodesis (LET) in those with high grade or explosive pivot shift tests. Ethics approval was obtained from the institutional ethics review committee. A total of 500 consecutive patients with ALRI were recruited for undergoing the combined procedure of ACLR with LET over a 1-year period. Demographic variables (age and gender) and functional outcome scores (International Knee Documentation Committee (IKDC), Lysholm, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Score and Functional Ankle Disability Index) were recorded pre-operatively and followed up at 3 months, 6 months, 1 year and 2 years post-surgery. Complications (pain, stiffness, residual laxity, re-rupture, infection, implant complications, shape change phenomenon) and return to sport were recorded. Of the 500 patients recruited, 482 patients (96.4%) completed the 2-year follow up. The mean age of the study population was 26.4 ± 2.1 years and 88% were males. VAS, IKDC and Lysholm scores showed significant improvement at each time frame during the study period and significant improvement at end of the study period versus baseline. Return to sport was achieved in 92% of study participants at an average period of 8.5 ± 1.6 months post-surgery with return to pre-injury level of 81%. Re-rupture rate was low (1.8%), and the most common complication was shape change phenomenon (a change in the shape of the knee compared with the contralateral knee; 18%). The present high-powered prospective cohort study shows that ACLR with LET provides yields excellent functional outcomes with a high return to sport rate and moderate complication rate in high-risk patients.