Functional Outcomes and Return to Sport of Combined ACL Reconstruction and Lateral Extra-Articular Tenodesis in High-Pivot Kabbadi Players: A Prospective Cohort Study of 93 Elite Players

Introduction

Our understanding of antero-lateral rotatory instability (ALRI) has evolved considerably, with a shift towards a combined procedure of ACL reconstruction and lateral extra-articular procedure (LEAP) to reduce ALRI and decrease graft re-rupture rates. Despite mounting evidence for the same in high-pivot and high-contact athletes in the West, there is a paucity of data for regional sports such as kabbadi. To the authors best knowledge, this is the first such study to track the outcomes of the combined procedure (ACLR and LEAP) in kabbadi players.

Methods

Ethics approval was obtained from the institutional ethics review committee. A total of 93 consecutive kabbadi players with ALRI were recruited for undergoing the combined procedure of ACLR with lateral extra-articular tenodesis. Demographical variables (age and gender) and functional outcome scores (IKDC, Lysholm, VAS, AOFAS, and FADI) were recorded pre-operatively and followed up at 6 week, 3 month, 6 month and 1 year post-surgery. In addition, complications (pain, stiffness, residual laxity, re-rupture, and infection) and return to sport were recorded.

Results

All 93 patients completed the prospective cohort study with no drop-outs. The mean age of the study population was 22.4 ± 2.7 years and 84% 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. AOFAS and FADI scores showed no significant difference between baseline and end of study period. There was no significant difference with respect to age and gender for knee (IKDC and Lysholm) or ankle (AOFAS and FADI) scores. Return to sport was achieved in 99% of study participants with return to pre-injury level was 86%. Re-rupture rate was low (n = 2 patients) and the majority of complications related to the LET (either a complaint of swelling or shape change phenomenon).

Conclusion

The present study shows that ACLR with LET provides a safe and effective option for treating kabbadi players engaged in an inherently high-pivot and high-contact sport. Knee outcomes (VAS, IKDC and Lysholm scores) showed substantial improvement versus baseline with a high degree of return to sport at pre-injury level and low re-rupture rate.