Do lateral extra-articular tenodeses play a role in the control of sagittal knee laxity in short hamstring tendon graft ACL reconstruction? A retrospective study of 80 cases with and without tenodesis.

Introduction: Lateral extra-articular tenodesis (LET) associated with an intra-articular anterior cruciate ligament reconstruction (ACLR) provides better rotational control, especially in knees with injuries to the anterolateral structures that are characterized by the presence of a gross pivot shift. However, the role of LET in the control of sagittal knee laxity remains debated. We hypothesized that LET plays a role in the control of sagittal knee laxity.

Patients And Methods: This was a retrospective, single-center, single-surgeon study of 80 patients operated on between January 2014 and December 2016 for a complete primary ACL tear. We compared 43 patients who underwent an isolated short hamstring tendon graft ACLR with 37 patients who underwent an ACLR using intra- and extra-articular grafts. Knee laxity measurements were taken with a GNRB® arthrometer preoperatively, at 1, 3, 6, and 9months (M1-M9), 1year, and at the last follow-up. The side-to-side differences (healthy vs. operated knees) in graft laxity (ΔL in mm) and compliance (ΔC in μm/N) were calculated for each patient from the generated force-displacement curves.

Results: No differences were found between the 2 groups in terms of the ΔL and ΔC evolvement profiles. All laxity parameters decreased significantly between the preoperative assessment and M1. ΔL and ΔC increased at low forces between M1 and M9. ΔL and ΔC stabilized after M9.

Discussion: Sagittal control remains the primary function of the ACL. The anterolateral ligament (ALL) reconstruction and LET do not improve sagittal postoperative laxity.

Conclusion: Sagittal laxity measurements recorded during the postoperative period did not show that adding LET to short hamstring tendon graft ACLRs improved either graft laxity or compliance.

Level Of Evidence: IV, retrospective study.