Risk of Graft Rupture After Adding a Lateral Extra-articular Procedure at the Time of ACL Reconstruction: A Retrospective Comparative Study of Elite Alpine Skiers From the French National Team
Sylvain Guy, Jean‐Marie Fayard, Adnan Saithna, Sami Bahroun, Alexandre Ferreira, Alessandro Carrozzo, Stéphane De Jesus, Stephane Bulle, Thaïs Dutra Vieira, Bertrand Sonnery‐Cottet
Abstract
Background: Elite alpine skiing is associated with a particularly high risk of anterior cruciate ligament (ACL) injuries, including graft ruptures. Despite a considerable focus on prevention, a reduction in injury rates has not been observed since the 1980s. Purpose: To determine whether elite alpine skiers undergoing ACL reconstruction (ACLR) with a lateral extra–articular procedure (LEAP) had a lower rate of ACL graft rupture when compared with those who underwent isolated ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Elite skiers from the French ski team who had undergone ACLR, with or without a LEAP, and had a minimum follow–up of 2 years were identified from the national ski team database. Rates of secondary ACL injury were determined via interrogation of the database, review of medical notes, and a final telemedicine interview. A multivariable analysis using the penalized Cox model was performed to explore the relationship among graft rupture, surgical procedure type, and any potential explanatory variables. Results: Among 81 ACLR procedures analyzed, 50 were isolated and 31 were combined with a LEAP, which was performed using modified Lemaire or anterolateral ligament reconstruction. Graft rupture rates were 34.0% in the isolated ACLR group and 6.5% in the ACLR + LEAP group. Multivariable analysis demonstrated that adding a LEAP was associated with a significant reduction in risk of ACL graft rupture when compared with isolated ACLR (hazard ratio [HR], 5.286 [95% CI, 1.068-26.149]; P = .0412). Age (HR, 1.114; P = .1157), sex (HR, 1.573; P = .3743), and ACL graft type (HR, 1.417; P = .5394) were not significant risk factors. Conclusion: Combined ACLR and LEAP were associated with a significant reduction in the rate of ACL graft rupture in elite alpine ski athletes. Those treated with isolated ACLR remain at extremely high risk of a second ACL injury.