Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Is Associated With Reduced Risk for Revision Anterior Cruciate Ligament Reconstruction in an Insurance Claims Database.

PURPOSE: To analyze a large, cross-sectional sample of patients from an administrative database for trends in the yearly utilization of either isolated anterior cruciate ligament (ACL) reconstruction or concomitant ACL reconstruction with lateral extra-articular tenodesis (ACLR/LET) for the treatment of ACL injury and to compare the cumulative incidence of 5-year reoperations and 90-day emergency visits for each treatment modality.

METHODS

International Classification of Diseases, Tenth Revision and Current Procedural Terminology codes were used to query the PearlDiver database between October 2015 and October 2022 to identify patients with a diagnosis of ACL injury undergoing either isolated ACLR or ACLR/LET. Propensity score matching was performed on the basis of age, sex, Charlson Comorbidity Index, overweight or obesity (body mass index >25.0), and tobacco use. Kaplan-Meier survival analysis was used to estimate the 5-year cumulative incidence of reoperations (revision ACLR, meniscus debridement/repair, adhesion lysis, knee joint manipulation, total knee arthroplasty) for each group.

RESULTS

In total, 1,022 patients underwent ACLR/LET, and 64,504 patients underwent ACLR for a diagnosis of ACL injury; following 1:1 propensity matching, 1,022 patients remained in each group. Patient counts for ACLR/LET increased yearly during the study period for every year except 2020, with greater than 20% increases annually after 2017. Kaplan-Meier analysis of revision ACLR in propensity-matched groups showed a 5-year cumulative incidence of 2.6% for patients undergoing ACLR/LET and 4.9% for ACLR (hazard ratio, 0.37; 95% confidence interval, 0.18-0.74; P = .005). There were no significant differences between groups and any other secondary event or postoperative complications.

CONCLUSIONS

ACLR/LET is increasingly utilized to treat patients with ACL tears and shows a decreased risk for revision ACLR without an increased risk for complications compared to patients treated with isolated ACLR.

LEVEL OF EVIDENCE: Level III, retrospective matched comparative series.