Study: Knee surgery benefits from extra step

Paul Mayne//Western NewsSchulich School of Medicine & Dentistry professor Alan Getgood has found that young athletes needing anterior cruciate ligament (ACL) reconstruction surgery may get a leg up by opting for an additional procedure that may drastically reduce the possibility of the injury reoccurring.

Young athletes needing anterior cruciate ligament (ACL) reconstruction surgery may get a leg up by opting for an additional procedure that may drastically reduce the possibility of the injury reoccurring, according to a Western-led study.

In the largest clinical trial of its kind, Schulich School of Medicine & Dentistry professor Alan Getgood, along with researchers at Lawson Health Research Institute, showed that performing a surgical procedure in addition to ACL surgery – called a lateral extra-articular tenodesis (LET) – may reduce the risk of ACL re-injury in patients under the age of 25.

While a knee injury can be devastating to a young athlete, LET creates a new ligament-like structure outside of the knee to provide additional support, Getgood explained.

The study included 624 participants from nine centres across Canada and Europe, including 196 patients from the Fowler Kennedy Sport Medicine Clinic at Western who were treated at University Hospital.

Helping control rotation of the knee, the ACL 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 created from a part of the patient’s body, such as one of the hamstring tendons or the tendon of the kneecap.

Unfortunately, the risk of a re-tear or graft failure in young athletes can be as high as 20 per cent, noted Getgood. The LET procedure, however, has “shown potential in improving patient outcomes.”

Half the study participants received standard care, consisting of ACL reconstruction, while the other half received ACL reconstruction with the additional LET procedure. Re-injury occurred in 11 per cent of patients receiving the standard care only, compared to only 4 per cent of patients who received both procedures.

“Adding the LET procedure resulted in a 65 per cent relative risk reduction for graft failure,” Getgood said. “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 also 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.

The paper, The Stability study: a protocol for a multicenter randomized clinical trial comparing anterior cruciate ligament reconstruction with and without Lateral Extra-articular Tenodesis in individuals who are at high risk of graft failure, was awarded Best Scientific Paper by the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine and the American Orthopaedic Society for Sports Medicine for this latest study.

Getgood has received funding from the Canadian Institutes of Health Research to conduct a follow-up study, which will compare ACL reconstruction with and without LET 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 used with either choice,” Getgood said. “Ultimately, we hope to enable patients in getting back to the activities they love most.”