Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return to Sports Rate as ACLR Alone, But Lower Failure Rate

Purpose To determine whether the addition of an LET to ACLR would improve return to sport rates in young, active patients who play high-risk sports. Methods This multicenter, RCT compared standard hamstring tendon ACLR with combined ACLR and LET, utilizing a strip of iliotibial band (Modified Lemaire). Patients aged 25 years or less with an ACL deficient knee were included. They also had to have two of the following criteria: 1) Grade 2 pivot shift or greater; 2) Participation in a high risk/pivoting sport; 3) Generalized ligamentous laxity. Time to return and level of return to sport was determined via administration of a questionnaire at 24 months postoperative. Results We randomized 618 patients and 553 played high-risk sports preoperative. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR + LET (14%) groups however, graft rupture rate was significantly different (ACLR = 11.2%, ACLR + LET = 4.1%, p = 0.004). Lack of confidence and fear of re-injury was the most cited reason for no RTS. A stable knee was associated with nearly two times greater odds of return to high-level high-risk sport postoperative (OR = 1.92, 95%CI: 1.11 to 3.35, p = 0.02). There were no significant differences in patient-reported functional outcomes or the hop test between groups (p>0.05). Patients who returned to high-risk sport had better hamstring symmetry than those who did not RTS (p = 0.001). Conclusions At 24-months postoperative, patients who underwent ACLR + LET had a similar RTS rate as those who underwent ACLR alone. While the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates. Level of evidence I – Randomized controlled trial