In combined ACL and meniscal damage, ACL reconstruction with
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A Study was conducted to determine if anterior cruciate ligament (ACL) reconstruction (ACLR) with lateral extraarticular tenodesis (LET) is beneficial for restoring knee kinematics with concomitant meniscal pathology causing rotatory knee instability.

20 patients with an ACL tear were randomized to either isolated ACLR or ACLR with LET. Patients were divided into four groups based on the surgery performed and the presence of meniscal tear (MT):
-ACLR without MT,
-ACLR with MT,
-ACLR with LET without MT, and
-ACLR with LET with MT.

Kinematic data normalized to the contralateral, healthy knee were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patient's knees during downhill running. Anterior tibial translation (ATT) and tibial rotation (TR) as well as patient-reported outcome measures (PROMs) were analyzed at 6- and 12-months postoperatively.

Results:
--At 6 months, ACLR with LET resulted in significantly decreased ATT at heel strike compared to ACLR.

--At 6 months, at toe off ACLR with LET better restored ATT to that of the contralateral, healthy knee in patients with meniscal pathology, while in patients without meniscal pathology, ACLR with LET resulted in significantly decreased ATT.

--There were no significant differences in kinematics or PROMs between groups at 12 months.

In particular, for combined ACL and meniscus injury, ACLR with LET restores native knee kinematics at toe off but excessively decreases ATT at heel strike in the early post-operative period (6 months) without altering knee kinematics in the long term.

Source: https://link.springer.com/article/10.1007/s00167-021-06476-0
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