By: 5 August 2019
Patients under the age of 25 who require ACL reconstruction may benefit from an  additional procedure

An anterior cruciate ligament (ACL) tear 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.

LET is the creation of a new ligament-like structure outside of the knee to provide additional support.

“Although the LET procedure has shown potential in improving patient outcomes, a randomised clinical trial was needed to assess whether or not it reduces the risk of re-injury,” said Alan Getgood, scientist at Lawson and orthopaedic knee surgeon at the Fowler Kennedy Sport Medicine Clinic.

Getgood led the STABILITY trial, which included 624 research participants from nine centres across Canada and Europe, including 196 patients from the Fowler Kennedy Sport Medicine Clinic treated 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 randomised to receive standard of care, consisting of ACL reconstruction without LET, and the other half received ACL reconstruction with the additional LET procedure. Re-injury occurred in 11 per cent of patients receiving the standard of care compared to only four per cent of patients who received ACL reconstruction with LET.

“Adding the LET procedure resulted in a 65 per cent relative risk reduction for graft failure,” says Dr Getgood. “Our results suggest patients under the age of 25 should consider the LET procedure when they have decided on ACL reconstruction using a hamstring graft.”

The research team studied a number of other outcomes including pain, athletic function, muscle strength and return to sports. Although the LET procedure resulted in slightly higher levels of post-operative pain and slightly decreased muscle strength in the three months following surgery, these complications did not persist. There were no differences in outcomes one and two years after surgery. 

“Our goal is to determine whether the choice of graft affects patient outcomes and whether or not LET should be used with either choice,” says Dr Getgood. “Ultimately, we hope to enable patients in getting back to the activities they love most.”  

Source: Lawson Health Research Institute