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
Juan Serna, Natalie Kucirek, Kirk Terada-Herzer, Drew A. Lansdown, C. Benjamin, Alan L. Zhang
Abstract
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.