Sports; An anterior cruciate ligament (ACL) tear, an injury of the knee, can be devastating to a young athlete. While the ACL can be reconstructed through surgery, there is a high risk of re-injury in patients under the age of 25. In the largest clinical trial of its kind, researchers at Lawson Health Research Institute have shown that performing an additional surgical procedure called lateral extra-articular tenodesis (LET) may reduce the risk of ACL re-injury in young athletes.
The ACL helps control rotation of the knee and is most commonly torn in sports involving sudden stops and changes in direction like soccer and basketball. ACL reconstruction surgery uses a graft to rebuild the torn ligament. Grafts are pieces of tissue commonly create from a part of the patient’s body, such as one of the hamstring tendons or the tendon of the kneecap (patellar tendon).
Potential in improving
Although the LET procedure has show potential in improving patient outcomes; so a randomize clinical trial was need to assess whether or not it reduces the risk of re-injury,” explains Dr. Alan Getgood, Scientist at Lawson and Orthopaedic Knee Surgeon at the Fowler Kennedy Sport Medicine Clinic; which is a collaborative partnership between London Health Sciences Centre (LHSC) and Western University.
Dr. Getgood led the STABILITY trial which include 624 research participants; so from nine centres across Canada and Europe, including 196 patients from the Fowler Kennedy Sport Medicine Clinic treat at University Hospital, LHSC. Participants were under the age of 25, undergoing ACL reconstruction using a hamstring graft and at high risk for re-injury.
Half the participants were randomize to receive standard of care; hence consisting of ACL reconstruction without LET; also the other half receive ACL reconstruction with the additional LET procedure. Re injury occur in 11% of patients receiving the standard of care; also compare to only 4% of patients who receive ACL reconstruction with LET.
Adding the LET procedure result in a 65% relative risk reduction for graft failure, says Dr. Getgood, also Assistant Professor at Western’s Schulich School of Medicine & Dentistry. Our results suggest patients under the age of 25 consider the LET procedure when they have decide on ACL reconstruction using a hamstring graft.
Return to sports
The research team study a number of other outcomes including pain; also athletic function, muscle strength and return to sports. Although the LET procedure result in slightly higher levels of post operative pain; also slightly decrease muscle strength in the three months following surgery; so these complications did not persist. There were no differences in outcomes one and two years after surgery.
The STABILITY trial was fund by the International Society of Arthroscopy; also Knee Surgery and Orthopaedic Sports Medicine (ISAKOS). Results were share last week at the ISAKOS Biennial Congress; so where the research group was award the Jan I. Gillquist Scientific Research Award for best scientific paper present at the meeting.
The study will compare ACL reconstruction with and without LET; so using two other types of grafts patellar tendon grafts and quadriceps tendon grafts. Our goal is to determine whether the choice of graft affects patient outcomes and whether or not LET should be use with either choice, says Dr. Getgood. “Ultimately, we hope to enable patients in getting back to the activities they love most.