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Over-the-Top ACL Reconstruction plus Extra-articular lateral tenodesis with hamstrings. Prospective evaluation with 20-year minimum follow-up.
Author(s):
Marcheggiani Muccioli G. (Italy)
,
Marcheggiani Muccioli G. (Italy)
Affiliations:
Zaffagnini S.
,
Zaffagnini S.
Affiliations:
Grassi A.
,
Grassi A.
Affiliations:
Signorelli Cecilia
,
Signorelli Cecilia
Affiliations:
Raggi F.
,
Raggi F.
Affiliations:
Roberti di Sarsina T.
,
Roberti di Sarsina T.
Affiliations:
Carbone G.
,
Carbone G.
Affiliations:
Marcacci M.
Marcacci M.
Affiliations:
ESSKA Academy. MARCHEGGIANI MUCCIOLI G. 05/09/18; 209471; P06-14 Topic: Arthroscopic Surgery
Dr. Giulio Maria MARCHEGGIANI MUCCIOLI
Dr. Giulio Maria MARCHEGGIANI MUCCIOLI
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Abstract
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Objectives: Background: There are few published studies with very long-term follow-up of combined intra- and extra-articular ACL reconstruction.
Purpouse: To analyze clinical and radiographic outcomes of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with autologous hamstrings at minimum 20-year follow-up.
Study Design: Case series; Level of evidence, 4.

Methods: Fifty-two patients (M/F:41/11; mean age at final follow-up 51.5±7.6 years) who underwent double-stranded hamstrings over-the-top ACL reconstruction (leaving intact graft tibial insertions) with extra-articular lateral plasty (performed with the remnant part of tendons) were prospectively evaluated at a minimum 20-year (mean 24-year) follow-up. Twenty-nine patients were available for prospective clinical (Lysholm, Tegner and objective IKDC), instrumental (KT-2000) and radiographic (standard, long-standing and Merchant views) evaluations. Subjective KOOS and objective inertial sensors pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications/re-rupture/revision-surgery.

Results: At final follow-up mean Lysholm score was 85.7±14.6, median Tegner score was 4 (range 3-5), sport activity resumption was 82.6% and objective IKDC score was good or excellent (A or B) in 86% of patients. Only 3/26 patients (12%) had >5 mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9 m/s2 tibial acceleration side-to-side difference) in these 3/26 patients (12%). Statistically significant changes were: decrease in Tegner score from 5-year to 10-year follow-up from 7(range 6-8) to 4 (range 3-5) (P<.0001) and decrease in Lysholm score from 10-year to 20-year follow-up from 96.1±7.3 to 85.7±14.6 (P=.0003).
Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knee in patients with concomitant medial meniscectomy (n=8; 3.2±0.6 Vs. 5.0±1.8mm; P=.0114). No significant differences were reported regarding lateral or patellofemoral joint space.
One patient (2%) experienced re-rupture, 3/52 (5.8%) patients contralateral ACL injury (excluded from KT-2000 and radiographic evaluations). Overall composite (objective IKDC/KT-2000/re-rupture) failure rate was 15.7% (4/29 clinical failures and 1/52 re-rupture) at final follow-up.

Conclusions: Studied surgical technique demonstrated a success rate of 84.3% at 20-year minimum follow-up. The lateral extra-articular plasty associated to ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.

Keywords:
anterior cruciate ligament (ACL) reconstruction, arthroscopy, extra-articular plasty, hamstrings, laxity
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