Re-Operation Rates After Combined ACL and ALL Reconstruction: A Series of 548 Patients With a Minimum Follow-Up of Two Years
Author(s):
Saithna A. (United Kingdom)
,
Saithna A. (United Kingdom)
Affiliations:
Thaunat M.
,
Thaunat M.
Affiliations:
Clowez G.
,
Clowez G.
Affiliations:
Cavalier M.
,
Cavalier M.
Affiliations:
Choudja E.
,
Choudja E.
Affiliations:
Dutra Vieira Thais
,
Dutra Vieira Thais
Affiliations:
Fayard J.
,
Fayard J.
Affiliations:
Sonnery-Cottet B.
Sonnery-Cottet B.
Affiliations:
ESSKA Academy. Saithna A. 05/09/18; 209429; P05-31
Prof. Adnan Saithna
Prof. Adnan Saithna
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Abstract
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Objectives: Early clinical results of anterolateral ligament (ALL) reconstruction are
promising, but concerns exist due to high rates of complications after other types of lateral extra-articular tenodesis. The rate of subsequent surgery following ALL reconstruction is not clearly defined. The aim of this study was to determine the rate of re-operation after combined ACL and ALL reconstruction.

Methods: A retrospective analysis of prospectively collected data was performed to include all patients who had undergone combined ACLR and ALL reconstruction between January 2012 and June 2014 at the included centres. At the end of the study period all patients were contacted by telephone and the operative notes of those who stated that they had undergone re-operation were reviewed to determine the rates and type of subsequent procedures performed. Descriptive data was analysed for the entire patient cohort.

Results: The study population comprised 548 combined ACL+ALL reconstructions. The mean age was 24.3 ± 7.9 years (range 11.9-55.7), 70.3% were male. The mean duration of follow-up was 35.5 ± 8.0 months (range 24-54). 72 patients (13.1%) underwent ipsilateral re-operation. This comprised a total of 77 procedures. Revision ACL reconstruction was performed in 14 knees (2.6%) at a mean of 18.3 (+/-7.4) months after the index procedure. There were 63 re-operations for ipsilateral, non-graft rupture related indications (meniscus n=30, arthrofibrosis n=22, removal of hardware n=4, deep infection n=3, arthroscopic lavage without infection n=4). The only specific complications related to the ALL procedure (n=3) were all related to femoral hardware which required removal. In both univariate and multivariate analyses, only the presence of a medial meniscal lesion at the index procedure was significantly associated with ipsilateral reoperation [OR, 2.58; 95% CI, 1.43-4.76; p=0.002].

Conclusions: The re-operation rate following combined ACL and ALL reconstruction in this series is broadly comparable to the re-operation rate after isolated ACL reconstruction, as reported in previous studies. In addition, the high rates of knee stiffness and re-operation reported in historical series of non-anatomical LET were not observed in the current series.

Keywords:
ACL, anterolateral ligament, re-operation, graft failure
Objectives: Early clinical results of anterolateral ligament (ALL) reconstruction are
promising, but concerns exist due to high rates of complications after other types of lateral extra-articular tenodesis. The rate of subsequent surgery following ALL reconstruction is not clearly defined. The aim of this study was to determine the rate of re-operation after combined ACL and ALL reconstruction.

Methods: A retrospective analysis of prospectively collected data was performed to include all patients who had undergone combined ACLR and ALL reconstruction between January 2012 and June 2014 at the included centres. At the end of the study period all patients were contacted by telephone and the operative notes of those who stated that they had undergone re-operation were reviewed to determine the rates and type of subsequent procedures performed. Descriptive data was analysed for the entire patient cohort.

Results: The study population comprised 548 combined ACL+ALL reconstructions. The mean age was 24.3 ± 7.9 years (range 11.9-55.7), 70.3% were male. The mean duration of follow-up was 35.5 ± 8.0 months (range 24-54). 72 patients (13.1%) underwent ipsilateral re-operation. This comprised a total of 77 procedures. Revision ACL reconstruction was performed in 14 knees (2.6%) at a mean of 18.3 (+/-7.4) months after the index procedure. There were 63 re-operations for ipsilateral, non-graft rupture related indications (meniscus n=30, arthrofibrosis n=22, removal of hardware n=4, deep infection n=3, arthroscopic lavage without infection n=4). The only specific complications related to the ALL procedure (n=3) were all related to femoral hardware which required removal. In both univariate and multivariate analyses, only the presence of a medial meniscal lesion at the index procedure was significantly associated with ipsilateral reoperation [OR, 2.58; 95% CI, 1.43-4.76; p=0.002].

Conclusions: The re-operation rate following combined ACL and ALL reconstruction in this series is broadly comparable to the re-operation rate after isolated ACL reconstruction, as reported in previous studies. In addition, the high rates of knee stiffness and re-operation reported in historical series of non-anatomical LET were not observed in the current series.

Keywords:
ACL, anterolateral ligament, re-operation, graft failure
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