Description
REVISION ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH QUADRICEPS TENDON AND LATERAL EXTRA-ARTICULAR TENODESIS : MID-TO LONG-TERM CLINICAL, RADIOLOGICAL AND FUNCTIONAL RESULTS
S. KASSAB HASSAN 1,2, G. ODRI 3, P. DJIAN 1
1 - Clinique Nollet, Paris, France, 2 - CHU Pitié-Salpêtrière, Paris, France, 3 - CHU Lariboisière, Paris, France
Topic: Knee - ACL
Objectives: To evaluate mid- to long-term results of an association of quadriceps tendon autograft and lateral extra-articular tenodesis for ACL revision surgery.
Methods: Patients who underwent revision ACL reconstruction with quadriceps tendon autograft and lateral extra-articular tenodesis between September 2002 et September 2015 operated by the senior author were included. Outcomes included clinical evaluation, validated clinical and patient reported outcome scores and radiographic analysis at last follow-up.
Results: Of the 109 patients eligible for inclusion, 90 were available for follow-up at mean 10,5 (± 3,3) years post-operatively. Anterior and rotatory laxity evaluated by Lachman and Pivot-shift tests as well as the side-to-side difference on a KT1000 arthrometer showed a significant improvement at latest follow-up (p<0,005). There were 20,5% of patients showing high grade (IKDC 3 or 4) residual pivot-shift.
IKDC B or more radiographic changes were correlated to the timing between injury to surgery (p=0,049) and to the existence of a meniscectomy during one of the surgeries (p=0,018). A meniscectomy during the first surgery was correlated to chondral changes (ICRS 3 or 4) during the revision surgery (p=0,023). Sports participations at last follow-up was important, 89% (n=80) of patients still practicing sports and 39% (n=31) of them the same sport than before the first ACL injury.
Patients with IKDC A or B pivot-shifts had better Tegner scores than patients with IKDC C or D pivot-shifts (6 (± 2) vs 4,2 (± 1,1), p=0,0024).
Re-rupture rate was 5,5% (n=5). At last follow-up, 36,7% (n=33) of patients had had a complementary surgery of the same knee (33% (n=11) of screw removal, 30% (n=10) of meniscectomies).
Conclusions: ACL revision surgery with quadriceps tendon autograft and lateral extra-articular tenodesis provides a maintained control of anterior and rotatory laxity, 10 years after surgery. Sports participation at latest follow-up was high. ICRS 3 or 4 chondral changes and high grade residual pivot-shift were associated with lower Tegner scores. Meniscectomy was associated with worsened radiographic outcomes. Re-operation rate was important (36,7%).
