Lateral Extra-Articular Tenodesis Reduces Graft Failure After Revision Anterior Cruciate Ligament Reconstruction without Compromising Return to Sport or Functional Outcomes
DOI:
https://doi.org/10.63403/re.v33i2.500Keywords:
Anterior cruciate ligament, Lateral extra-articular tenodesis, Return to sport, Failure plasty ACL, Functional outcomesAbstract
Introduction: revision anterior cruciate ligament reconstruction (ACLR) is a complex procedure associated with poorer outcomes and higher graft failure rates than primary reconstruction. Because residual rotatory instability may increase graft load, lateral extra-articular tenodesis (LET) has emerged as an adjunctive procedure to improve rotatory control and potentially reduce graft rerupture. However, its impact on patient-centered outcomes, particularly return to sport, remains uncertain.
Objectives: the aim of this study was to evaluate the effect of LET on graft failure, functional outcomes, and return to sport in patients undergoing revision ACLR.
Materials and methods: a retrospective comparative cohort study was performed. Skeletally mature patients who underwent first-time revision ACLR between 2014 and 2020 with a minimum follow-up of 4 years were included. A total of 113 patients were analyzed: 53 underwent isolated revision ACLR and 60 underwent revision ACLR combined with LET. The primary outcome was return to sport, defined as resumption of any sports activity; return to pre-injury level was also recorded. Secondary outcomes included time to return to sport, subjective IKDC, Tegner score, and graft failure.
Results: the mean age and follow-up was 27.1 ± 8.0 years, and 6.0 years, respectively. Functional outcomes were comparable between groups: IKDC 80.4 ± 9.2 vs. 84.1 ± 8.8; p = 0.86, and Tegner 6.6 ± 1.3 vs. 6.7 ± 1.2; p = 0.92. Overall, 68 patients (60%) returned to some sports activity, and 45 (40%) returned to their preinjury level. Although return to sport was higher in the LET group, the difference was not statistically significant (p = 0.41). Graft failure was lower with LET (3% vs. 19%; p = 0.03), corresponding to a reduced risk of rerupture (OR 0.15; 95% CI, 0.03-0.72).
Conclusion: in revision ACLR, the addition of LET was associated with a lower risk of graft rerupture, without statistically significant differences in return to sport or functional outcomes.
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Copyright (c) 2026 Waldo Gonzalez, Jorge Isla, Alfredo Sandoval, Minerva Itriago, David Figueroa
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