作者
Alex Rezansoff,Andrew Firth,Dianne Bryant,Robert Litchfield,Robert G. McCormack,Mark Heard,Peter B. MacDonald,Tim Spalding,Peter Verdonk,Devin Peterson,Davide Bardana,Alan Getgood,Alan Getgood,Dianne Bryant,Robert Litchfield,Kevin Willits,Trevor B. Birmingham,Chris Hewison,Andrew Firth,Ryan Pinto,Ashley Martindale,Lindsey O’Neill,M. Jennings,Michal Daniluk,Robert G. McCormack,Dory Boyer,Mauri Zomar,Mark Heard,Gregory M. Buchko,Laurie A. Hiemstra,Sarah Kerslake,Jeremy Tynedal,Peter B. MacDonald,Greg Stranges,Sheila McRae,Holly Brown,Alex Rezansoff,Nick Mohtadi,Denise Chan,Alexandra Garven,Devin Peterson,Nicole Simunovic,Andrew Duong,Matt Skelly,Ajaykumar Shanmugaraj,Davide Bardana,Fiona Howells,Tim Spalding,P. Thompson,Andrew Metcalfe,Peter Verdonk,Geert Declerq
摘要
To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) would improve return-to-sport (RTS) rates in young, active patients who play high-risk sports.This multicenter randomized controlled trial compared standard hamstring tendon ACLR with combined ACLR and LET using a strip of the iliotibial band (modified Lemaire technique). Patients aged 25 years or younger with an anterior cruciate ligament-deficient knee were included. Patients also had to meet 2 of the following criteria: (1) pivot-shift grade 2 or greater, (2) participation in a high-risk or pivoting sport, and (3) generalized ligamentous laxity. Time to return and level of RTS were determined via administration of a questionnaire at 24 months postoperatively.We randomized 618 patients in this study, 553 of whom played high-risk sports preoperatively. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR-LET (14%) groups; however, the graft rupture rate was significantly different (11.2% in ACLR group vs 4.1% in ACLR-LET group, P = .004). The most cited reason for no RTS was lack of confidence and/or fear of reinjury. A stable knee was associated with nearly 2 times greater odds of returning to a high-level high-risk sport postoperatively (odds ratio, 1.92; 95% confidence interval, 1.11-3.35; P = .02). There were no significant differences in patient-reported functional outcomes or hop test results between groups (P > .05). Patients who returned to high-risk sports had better hamstring symmetry than those who did not RTS (P = .001).At 24 months postoperatively, patients who underwent ACLR plus LET had a similar RTS rate to those who underwent ACLR alone. Although the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates.Level I, randomized controlled trial.