Additional Surgical Procedure Linked to Better ACL Reconstruction Outcomes

By Hillary Eames
Tuesday, November 12, 2019

The lateral extra-articular tenodesis (LET) procedure, when performed in conjunction with ACL reconstruction, may reduce young athletes’ risk of graft failure and reinjury, according to a recent clinical trial.

For young adult or adolescent athletes, an ACL injury can be especially detrimental, as reinjury is common among ACL repair patients younger than age 25. Surgeons generally replace the torn ligament with an autograft or allograft ligament transplant, but the risk of a graft failure or re-tear is as high as 20% in these athletes.

Canadian researchers have found that performing LET in addition to ACL graft repair may improve outcomes.

STABILITY Clinical Trial

There are multiple techniques, but generally, LET affixes part of the iliotibial band to the femur above the knee joint. This provides the knee joint with additional support and stabilizes knee rotation.

“Although the LET procedure has shown potential in improving patient outcomes, a randomized clinical trial was needed to assess whether or not it reduces the risk of reinjury,” says Alan Getgood, MD, FRCS, scientist at Lawson Health Research Institute and orthopedic knee surgeon at Fowler Kennedy Sport Medicine Clinic in London, Ontario, in a press release about the STABILITY trial.

The study included 624 participants from nine centers in Europe and Canada. Patients were under the age of 25, undergoing a hamstring graft for ACL repair and had high risk of reinjury. Half of the patients were randomized to receive ACL reconstruction with LET, and half received ACL reconstruction alone. While 11% of patients experienced reinjury after ACL reconstruction without LET, only 4% who underwent both ACL reconstruction and LET experienced reinjury.

“Adding the LET procedure [also] resulted in a 65% relative risk reduction for graft failure,” Dr. Getgood says in the release. “Our results suggest patients under the age of 25 should consider the LET procedure when they have decided on ACL reconstruction using a hamstring graft.”

Dr. Getgood is conducting a follow-up study comparing the use of LET in ACL reconstruction with two other types of tendon grafts.

Improving Healing After ACL Injury

Young athletes should wait at least one year after ACL reconstruction to return to their sports, Susanne Beischer, PhD, registered physical therapist in Gothenburg, Sweden, concludes in her recent thesis.

The thesis references five substudies, four of which she uses to make the recommendation that young athletes’ rehabilitation should last at least a year. Beischer found the athletes were significantly less likely to experience new ACL injuries if they did not return to their sports too soon.

She also believes a multidisciplinary approach to ACL repair is necessary to enhance outcomes.

“A surgical procedure alone cannot solve the problem of reinjuries,” Beischer says. “The solution is ... interprofessional clinical work and research. Even if the orthopedic surgeon makes an absolutely perfect reconstruction, the result may not be perfect if the rehabilitation is insufficient.”