Lateral extra‐articular tenodesis does not enhance ACL graft healing, however, does reduce graft tunnel widening

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 32; no. 11; pp. 2885 - 2894
• Main Authors: Jacob, George, Lim, Yoong Ping, Brito, Cristian Ayet, Parker, David A.
• Format: Journal Article
• Language: English
• Published: Germany 01-11-2024
• Subjects: ACL reconstruction; graft incorporation; lateral extra‐articular tenodesis; ligamentization; graft incorporation; ACL reconstruction; ligamentization; lateral extra‐articular tenodesis
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1002/ksa.12310

Purpose
The study hypothesized that the addition of lateral extra‐articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing.
Methods
A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post‐operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post‐surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal‐to‐noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient‐reported outcome measures were collected.
Results
The mean femoral tunnel widening at 12 months post‐surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.).
Conclusion
At 1 year post‐operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing.
Level of Evidence
Level III.