Outcomes of All-Inside Arthroscopic ACL Reconstruction with Lateral Extra-Articular Tenodesis (ACLR + LET).

Abstract

Background: Anatomic single-bundle ACL reconstruction (ACLR) produces good results when the graft and tunnel are positioned in the anatomic footprint on the femoral and tibial insertion sites in a more oblique orientation. The Anterolateral Complex of the knee and its biomechanical role in controlling rotational laxity, internal rotation, and pivot shift has led to adding adjunctive procedures like extra-articular augmentation and lateral extra-articular tenodesis (LET) to decrease rotational laxity. We prospectively analyzed young adults with rotational instability and generalized laxity undergoing an arthroscopic single bundle ACLR with an additional LET procedure.

Methods: 42 patients, aged between 20 and 50, undergoing all-inside ACLR augmented with concomitant lateral extra-articular tenodesis between November 2020 and October 2021 were included. All patients were followed up for one year and functional assessment comprised of the International Knee Documentation Committee [IKDC] score, visual analogue score [VAS], and Lysholm Knee Scoring Scale at 6 months and 1 year. Return to activity was assessed using the Tegner Activity Score.

Results: The Lysholm score, IKDC score, and VAS showed significant improvements at 6 months after ACLR + LET (p < 0.0001) and further improved significantly at 1 year. The patients had a significant decline in the Tegner Activity Scale at 6 months but returned to the near pre-injury level (5.98 ± 0.924) at 1 year (5.67 ± 0.816) which was insignificant (p = 0.1067). Three patients sustained mild complications. 93% were satisfied with the surgery, 66% returned to sports and no patient underwent re-operation.

Conclusions: Combination of LET with ACLR produces good functional outcomes, high rates of return to sports activities, and no graft failure in young patients at high risk of failure.