The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL reconstruction alone in patients undergoing ACL revision surgery

Background: Recent years have seen a resurgence of interest about lateral extra-articular procedures performed in association with anterior cruciate ligament (ACL) surgery, as they can reduce the positivity to pivot shift test by acting on rotational instability. The purpose of the present study is to compare the postoperative functional outcomes of ACL revision surgery using contralateral hamstring tendon autografts with or without extra-articular tenodesis. Hypothesis: The hypothesis is that combined extra-articular tenodesis gives better rotational stability following revision ACL surgery. Patients and methods: Twenty-four patients who underwent ACL revision surgery were retrospectively reviewed at an average follow-up of 4.5 years; 12 underwent contralateral hamstring tendon autografts reconstruction (group A) while in 12 extra-articular tenodesis was associated (group B). Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level and objective evaluation (range of motion, Lachman test, pivot-shift test and KT-1000 instrumented laxity testing). Results: Follow-up examination showed that there were no statistically significant differences in Lysholm, IKDC and Tegner scores between the groups (p = n.s.). Similarly, no differences concerning anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups (p = n.s.); the percentage of positivity to pivot shift test was significantly higher in patients in group A (p < 0.05). Conclusions: The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL revision surgery alone. Level of evidence: IV.