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Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players

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Abstract

Purpose

The growing popularity of elite soccer among female participants has led to increased incidents of anterior cruciate ligament (ACL) ruptures. Many authors underline a positive glide after ACL reconstruction (ACLR), especially in women. In fact, an isolated intra-articular ACLR may be inadequate to control rotational instability after a combined injury of the ACL and the peripheral structures of the knee. Extra-articular procedures are sometimes used in primary cases displaying excessive antero-lateral rotatory instability. The purpose of this case series was to report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis (LET) with a minimum 4-year follow-up in a selected high-risk population of elite female football players.

Methods

Between January 2007 and December 2010, 16 elite Italian female football players were included in the study. All patients underwent the same surgical technique: anatomical ACLR with autogenous semitendinosus and gracilis tendons. After the intra-articular reconstruction was performed, an additional extra-articular MacIntosh modified Coker–Arnold procedure was carried out. Patients were assessed pre- and post-operatively with the subjective and objective International Knee Documentation Committee (IKDC) evaluation form, Tegner activity scale (TAS) and Lysholm score. Joint laxity was assessed with KT-1000 by measuring the side-to-side (S/S) differences in displacement at manual maximum (mm) testing.

Results

At a mean follow-up of 72.6 ± 8.1 months, two independent examiners reviewed all players. All of the patients had a fully recovered range of motion. Lachman test was negative in all patients (100 %). The evaluation of joint laxity and clinical evaluation showed a statistically significant improvement. No patients experienced complication or a re-rupture.

Discussion

The rationale of combining extra-articular procedures with ACLR is to restrict the internal rotation of the reconstructed knee, taking advantage of its long lever arm and thus providing more stability in the rotational axis and preventing the ACL graft from undergoing further excessive strain.

Conclusions

The combination of an LET with ACLR in elite female football players demonstrated excellent results in terms of subjective scales, post-operative residual laxity and re-rupture rate with no complication, and a complete return to sport activity.

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Authors and Affiliations

  1. Unit of Orthopaedics and Traumatology, S. Andrea Hospital, University of Rome “Sapienza”, Via Grottarossa, 1035, Rome, Italy

    Matteo Guzzini, Daniele Mazza, Mattia Fabbri, Riccardo Lanzetti, Andrea Redler, Carlo Iorio, Edoardo Monaco & Andrea Ferretti

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  1. Matteo Guzzini
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  2. Daniele Mazza
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  3. Mattia Fabbri
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  4. Riccardo Lanzetti
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  5. Andrea Redler
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  6. Carlo Iorio
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  7. Edoardo Monaco
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  8. Andrea Ferretti
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Correspondence to Daniele Mazza.

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Prof. Andrea Ferretti is a consultant for Arthrex.

The other authors declare that they have no conflicts of interest.

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Prof Andrea Ferretti is a consultant for Arthrex.

The other authors declare that they have no conflicts of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Guzzini, M., Mazza, D., Fabbri, M. et al. Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players. International Orthopaedics (SICOT) 40, 2091–2096 (2016). https://doi.org/10.1007/s00264-016-3261-9

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  • DOI: https://doi.org/10.1007/s00264-016-3261-9

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