CLINICAL OUTCOMES AND FAILURE RATES IN PATIENTS UNDERGOING REVISION ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH OR WITHOUT MODIFIED LEMAIRE LATERAL EXTRA-ARTICULAR TENODESIS

The purpose of this study was to perform a comparative analysis between patients who underwent R-ACLR with or without a modified Lemaire LET and report their PROMs, return to sport rate, and graft failure rate during the predetermined follow-up period. A retrospective review of medical records of patients who underwent R-ACLR with or without a modified Lemaire LET was performed. Seventy-four patients with ≥ 2 years follow-up, who had a high-grade positive pivot shift test under anesthesia (≥ 2) were included. Concomitant procedures such as meniscectomy, meniscal repair, and LET, were collected along with any re-operations, complications, and/or graft failure. Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) Subjective Knee Form were collected. The ability to return to sports after the R-ACLR was defined as fully, partially, or not returned. Postoperative radiologic measurements included medial posterior tibial slope (PTS) angle, lateral femoral condylar ratio (LFCR), and osteoarthrosis (OA) grade. An ANCOVA was used to compare PROMs between groups, adjusted for patient age, study site, and length of follow-up. Statistical significance was set at p < 0 .05 for all analyses. Thirty-nine patients underwent isolated R-ACLR (mean age (SD±) 29.2 ±12.2) and 35 had an additional LET (24.6 ±7.4). The mean length of follow-up in the R-ACL group was 56.6 ±26.5 months compared to 44.3 ±17.6 months (p = 0.02*) (range 24 – 120 months) in the R-ACLR LET group. PROMs were higher in the LET group with KOOS ADL (93.5 ± 2.0; 97.2 ± 1.6; p=0.03) and KOOS Sport (63.0 ± 3.6; 74.3 ± 3.8; p=0.05) subdomains reaching statistical significance, with the latter reaching a minimum clinically important difference threshold. No other differences were found in the other KOOS subdomains or IKDC scores. Failure rates were not significantly different between the groups (12.8% for R-ACLR vs 11.4% for R-ACLR + LET; p=0.99). Of patients that played competitive pivoting sports, there was no difference in the proportion that did not return, partially returned, or fully returned to sport postoperative. Postoperatively, 13 (72.2%) patients in the R-ACLR group and 14 (60.8%) patients in the R-ACLR + LET group did not return to sports. R-ACLR with additional LET showed a similar failure and return to sport rates compared to isolated R-ACLR following failed ACLR. However, LET augmentation of R-ACLR provided better functional results with significantly higher activities of daily living, and sport and recreation KOOS subdomain scores.