ACL Reconstruction using Hamstring Autograft Plus Lateral Extra-articular Tenodesis and All-Soft Tissue Quadriceps Alone Have Lower Re-tear Rate and Pivot Shift Grade but Similar Outcome to Hamstring Autograft Alone in High Risk Patients.

Abstract

Purpose: The purpose of this study was to compare the surgical outcomes of anterior cruciate ligament (ACL) reconstruction using hamstrings autograft (HA) plus lateral extra-articular tenodesis (LET), isolated all-soft-tissue quadriceps autograft (QA), and isolated HA.

Methods: A retrospective review was performed comparing high risk patients undergoing ACL reconstruction with isolated HA, isolated QA, or HA+LET from August 2013 to January 2023. High risk patients, as determined by high grade pivot shift or generalized ligament laxity, with at least 2 years of follow up were included. Lysholm and International Knee Documentation Committee (IKDC) scores were compared at 3, 6, 12, and 24 months postoperatively. Re-tear rate, postoperative pivot shift grade, return to sport, and complications were recorded.

Results: 159 patients (56 HA, 47 HA+LET, and 56 QA) were included. At 6 months postoperatively the HA IKDC score was significantly lower than the HA+LET and QA groups (p<0.0001). Similarly, the Lysholm score was significantly lower in the HA cohort at 6 months, 1 year, and 2 years postoperatively (p <0.0001-0.02). There was no difference in rate of achieving minimally important clinical difference between the cohorts for either of these outcome scores. The re-tear rate was significantly higher in the HA group (17.9%) compared to the HA+LET (4.3%) and QA (1.8%) cohorts (p=0.01). The rate of postoperative pivot shift of grade 2 or more was also higher in the isolated HA group (p=0.04).

Conclusion: The use of an all-soft-tissue QA or HA+LET for ACL reconstruction both resulted in a lower re-tear rate and postoperative pivot shift grade compared to an isolated HA graft in high-risk patients at two years postoperatively. There was no difference in the rate of achieving minimal clinically important difference between the cohorts. The QA and HA+LET reconstruction options may improve stability and decrease the failure rate compared to HA reconstruction alone.