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J Knee Surg 2025; 38(04): 207-215
DOI: 10.1055/a-2481-8771
Original Article

Isolated Lateral Extra-Articular Tenodesis for Ongoing Instability Following Anterior Cruciate Ligament (ACL) Reconstruction with an Intact Graft is Effective and Has Low Surgical Morbidity

Authors

  • Peter S.E. Davies 

    1   Orthopaedic Research Foundation of Western Australia, Perth, Western Australia
    2   Department of Trauma and Orthopaedics, Fiona Stanley and Fremantle Hospitals Group, South Metropolitan Health Service, Perth, Western Australia

  • Cameron Muirhead

    1   Orthopaedic Research Foundation of Western Australia, Perth, Western Australia
    2   Department of Trauma and Orthopaedics, Fiona Stanley and Fremantle Hospitals Group, South Metropolitan Health Service, Perth, Western Australia

  • Alistair I.W. Mayne

    1   Orthopaedic Research Foundation of Western Australia, Perth, Western Australia
    2   Department of Trauma and Orthopaedics, Fiona Stanley and Fremantle Hospitals Group, South Metropolitan Health Service, Perth, Western Australia

  • Jay R. Ebert

    1   Orthopaedic Research Foundation of Western Australia, Perth, Western Australia
    3   School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia
    4   HFRC Rehabilitation Clinic, Perth, Western Australia

  • Peter K. Edwards

    1   Orthopaedic Research Foundation of Western Australia, Perth, Western Australia
    5   School of Allied Health, Curtin University, Perth, Western Australia

  • Ashley Simpson

    6   Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital, London, United Kingdom

  • Andy Williams

    7   Fortius Clinic, London, United Kingdom

  • Peter D'Alessandro

    1   Orthopaedic Research Foundation of Western Australia, Perth, Western Australia
    2   Department of Trauma and Orthopaedics, Fiona Stanley and Fremantle Hospitals Group, South Metropolitan Health Service, Perth, Western Australia
    8   Division of Surgery, Medical School, University of Western Australia, Perth, Western Australia

Funding The authors declare that no funding was required for the execution or reporting of this study.
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Abstract

The management of persisting instability following anterior cruciate ligament reconstruction (ACLR) includes isolated lateral extra-articular tenodesis (LEAT). The present study investigates the outcomes following isolated LEAT to address ongoing instability following ACLR without LEAT. Patients with ongoing symptomatic instability following ACLR with a radiologically intact and well-positioned graft who underwent an isolated LEAT between January 2017 and March 2022 were retrospectively recruited. Patients completed patient-reported outcome measures at baseline and mean 26 months postoperatively. Twelve knees in 11 patients underwent an isolated LEAT. All Knee Injury and Osteoarthritis Outcome Score domains improved significantly between pre- and postoperative measurements (pain 60.9–91.7, p = 0.002; symptoms 62.5–93.8, p = 0.003; activities of daily living 64.3–95.2, p = 0.002; sport 61.9–82.5, p = 0.012; quality of life 17.2–80.2, p = 0.002). One patient required revision ACL surgery 19 months following their subsequent LEAT procedure. An isolated LEAT demonstrated clinically significant improvements in patient function and activity with acceptable surgical morbidity and should be considered as an option for appropriate cases with instability despite an intact ACL graft.

Level of evidence Level IV prospective case series

Keywords

ACL - anterior cruciate ligament - instability - PROMs - patient-reported outcome measure - instability - lateral tenodesis - LET - LEAT

Ethical Approval

Ethical approval was obtained from the local institutional ethics committee.


Informed Consent

All study participants gave informed consent for their involvement in the study prior to enrollment.


Authors' Contribution

P.D. participated in data collection, statistical analysis, writing the manuscript, preparing the manuscript in the journal format, and submission to the journal. C.M. participated in data collection and drafting the manuscript. A.M. participated in data collection, drafting the manuscript, and proofreading the manuscript. J.E. participated in the design of the study, data collection, drafting the manuscript, and proofreading the manuscript. P.E. participated in the design of the study, drafting the manuscript, statistical analysis, and proofreading the manuscript. A.S. developed the concept of the study and participated in the design of the study and proofreading the manuscript. A.W. developed the concept of the study and participated in drafting and proofreading the manuscript. P.D.A.L. developed the concept of the study and participated in the design of the study, data collection, statistical analysis, drafting, and proofreading of the manuscript.




Publication History

Received: 09 July 2024

Accepted: 21 November 2024

Accepted Manuscript online:
22 November 2024

Article published online:
19 December 2024

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