ACL reconstruction with extra-articular procedure may reduce graft rupture rate
SAN FRANCISCO — Results showed elite alpine skiers who underwent ACL reconstruction combined with an extra-articular procedure had a fivefold reduction in the rate of ACL graft rupture compared with ACL reconstruction alone.
Adnan Saithna, MD, FRCS(Ortho), and colleagues compared outcomes between 59 elite alpine skiers on the French national ski team who underwent either isolated ACL reconstruction or ACL reconstruction combined with an extra-articular procedure. Researchers analyzed contralateral injuries separately, using “first ACL-injured knee” and “contralateral ACL-injured knee” to delineate between the two.
“We used exposure time to evaluate outcomes rather than the specific time from the time of surgery. We used that because we wanted to understand the impact of the effect of being at high risk of graft rupture,” Saithna said in his presentation at the Arthroscopy Association of North America Annual Meeting. “We calculated this on their time from return to international competition to either the time of graft rupture, their exit or time off from the team, or the end of the study period for those who didn’t sustain a graft rupture.”
Saithna noted patients in the isolated ACL reconstruction group had a graft rupture rate of 34% vs. 6.5% in the combined ACL reconstruction group.
“When we evaluated this in a multivariate analysis, we found isolated ACL reconstruction had a risk of rupture five times higher,” Saithna said.
He said patients in the isolated ACL reconstruction group had several early failures, with two skiers sustaining a rupture in the first 2 months of return to competition and a total of four re-ruptures occurring within the first postoperative year. However, the combined ACL reconstruction group had no early failures, one failure at 3 years postoperatively and one failure at 7 years postoperatively, according to Saithna.
“With respect to non-graft rupture-related reoperations, there were no significant differences between groups,” Saithna said.
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Saithna A, et al. Lateral extra-articular procedures significantly reduce ACL graft rupture rates in elite alpine skiers. Presented at: Arthroscopy Association of North America Annual Meeting. May 19-21, 2022; San Francisco.
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