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ACL Reconstruction with Lateral Extraarticular Tenodesis Better Restores Native Knee Kinematics

February 6, 2022

Several orthopaedic experts, including UPMC Orthopaedic Care physicians Jonathan Hughes, MD, Bryson Lesniak, MD, and Volker Musahl, MD, recently published a study in Knee Surgery, Sports Traumatology, Arthroscopy to determine if anterior cruciate ligament (ACL) reconstruction (ACLR) with lateral extraarticular tenodesis (LET) is beneficial for restoring knee kinematics with concomitant meniscal pathology causing rotatory knee instability.

In this study, 20 patients with an ACL tear were randomized to either isolated ACLR or ACLR with LET groups. Patients were divided into four subgroups based on the surgery performed and the presence of meniscal tear (MT):

1. ACLR without MT
2. ACLR with MT
3. ACLR with LET without MT
4. ACLR with LET with MT

Data regarding knee motion were collected and normalized to the healthy contralateral knee, using dynamic biplanar radiography. The images were superimposed with high-resolution computed tomography scans of patients’ knees during downhill running. Anterior tibial translation (ATT), tibial rotation (TR), as well as patient-reported outcome measures (PROMs) were analyzed at the 6- and 12-month postoperative intervals.

At 6 months, ACLR with LET resulted in reduced ATT at heel strike compared to ACLR. At 6 months, at toe off ACLR with LET better restored ATT to that of the contralateral, healthy knee in patients with meniscal pathology. In patients without meniscal pathology, ACLR with LET resulted in significantly decreased ATT. No differences in knee motion or PROMs were observed between groups at 12 months.

With the available sample size of this pilot study, for combined ACL and meniscus injury, this study showed that ACLR with LET may restore knee motion comparable to the native state at toe off.

However, ATT is excessively decreased at heel strike during the early post-operative period (6 months) without an impact on long-term knee motion (12 months). Future large-scale clinical studies are needed to better understand the function of LET and ultimately improve patient outcomes.

Read more about this study on SpringerLink.

Other study authors include:

Christopher Gibbs, MD
Adam Popchak, DPT, PhD, SCS
William Anderst, PhD

Collaborators not affiliated with the University of Pittsburgh:

Daisuke Chiba, MD
Hirosaki University