La reconstruction combinée du LCA et du ligament antérolatéral est-elle associée à un risque plus important de complications ? Résultats préliminaires d’une étude prospective randomisée - 21/11/19
Combined ACL and anterolateral ligament reconstruction is not associated with a higher risk of adverse Outcomes than isolated ACL reconstruction: preliminary results of a randomized controlled trial
, Bertrand Sonnery-Cotte 2, Thais Dutra Vieira 2, Florent Franck 2, Charles Kajetanek 3, Jean-Marie Fayard 2, Mathieu Thaunat 2, Adnan Saithna 4Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Résumé |
Background |
The widespread historical abandonment of lateral extra-articular procedures in ACL-injured knees occurred due to concerns about high rates of adverse events. Recently there has been a resurgence in popularity of lateral extra-articular procedures and this warrants an urgent evaluation of their safety profile.
Hypothesis/Purpose |
The aim of this study was to perform an interim analysis of the ongoing (blinded for journal review) randomized controlled trial in order to determine whether combined ACL and anterolateral ligament reconstruction (ACL+ALLR) is associated with an increased rate of adverse outcomes when compared to isolated ACL reconstruction (ACLR). The hypothesis was that there would be no significant difference between groups at a minimum follow-up of one year.
Study Design |
Randomized Controlled Trial
Methods |
Recruitment was commenced in November 2016. Patients scheduled for ACL reconstruction were randomized to either isolated ACL reconstruction (bone-patella tendon-bone autograft) or combined ACL+ALLR (hamstring tendon autograft). All patients with a minimum follow-up of one year, in March 2019 were included. Complications and re-operations, knee laxity parameters, range of motion, Tegner, Lysholm, IKDC and KOOS scores were evaluated.
Results |
Deux cent vingt quatre patients (112 in each group) with a mean follow-up 12.3±1.9 (range 12 to 19) months formed the study population. There was a significantly higher rate of re-operation for cyclops syndrome in the isolated ACL group (B-PT-B 8.9 %, ACL+ALLR 0 %, p=0.0012). There was no significant difference in the frequency of graft rupture (B-PT-B 5.4 %, ACL+ALLR 0.9 %, p=0.1191), range of motion deficits, pain, or re-operation for meniscectomy between groups. There were no cases of post-operative infection, venous thromboembolism, or arthrofibrosis. Subjective IKDC (81.2 vs. 86.8, p=0.0048), Lysholm (88 vs. 92, p=0.0131) and some components of KOOS were significantly better in the ACL+ALL group.
Conclusion |
This study demonstrates no evidence of an increased risk of adverse events after combined ACL+ALL reconstruction when compared to isolated ACL reconstruction with a B-PT-B graft. The trend towards a reduced graft rupture rate and significantly better subjective IKDC, Lysholm and KOOS scores with the combined procedure is consistent with the previous literature and expected to be more pronounced at the end of the overall study period.
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Vol 105 - N° 8S
P. S105-S106 - décembre 2019 Retour au numéro
Article précédent
- Peut-on palper l’insertion distale tibiale du ligament antérolatéral pour identifier sa lésion dans les ruptures du ligament croisé antérieur ?
- Etienne Cavaignac, Jérôme Murgier, Pierre Thomas, Louis Courtot, Vincent Marot
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- Etienne Caron, Mathieu Thaunat, Bertrand Sonnery-Cottet, Thais Dutra Vieira, Jean-Marie Fayard
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