Paper 28: Both Hamstring Autograft Combined with Lateral Extra-Articular Tenodesis and Quadriceps Autograft Lead to Lower Graft Re-Tear Rates and Pivot Shift After ACL Reconstruction Compared to Hamstring Autograft Alone

Objectives: ACL reconstruction using hamstring autograft (HA) has been found to have a high re-tear rate in risk patients including those with Pivot shift of 2 or higher and generalized ligamentous laxity (GLL). Because this, the use lateral extra-articular tenodesis (LET) gained traction sports community. Several studies shown lower graft re-tears addition LET is felt by many be necessary when HA patients. However, no study compared + versus other types. The purpose our was compare surgical outcomes HA+LET vs an all-soft-tissue quadriceps (QA) without LET. We hypothesized that QA would lead similar rotational instability rates as HA+LET. Methods: This retrospective more GLL undergoing either HA, QA. In this study, defined Beighton score 4 more. Patients were included if they primary (HA group), (HA+LET group) (QA procedures than meniscal work. All surgeries performed senior surgeon followed same rehabilitation protocol after surgery regardless what type used during surgery. Graft choice dependent on procedure performed. Early period, most whether not. Later, due emerging showing failure alone Finally, author transitioned for cases. Patient reported (PROs) obtained each patient preoperatively, 3,6,12 24-months PROs International Knee Documentation Committee (IKDC) Lysholm scores. Clinical who had residual pivot tested at 6,12 24-month follow up. Other complications associated documented. Results: A total 166 underwent over 7 year period. There 63 group, 47 56 group. demographics between three groups overall age being 17.8 years. mean 3.2 group 24% population having GLL. Grade 82%. difference regards percentage 2+pivot shift. women men 66%; 62% 56%), but there significant groups. significantly larger diameter (9.6mm) (7.9mm) (8.1mm) (p<.001). number repair partial meniscectomy all 21.1% 48% entire repair. made up 68.4% athletes 62.4% 72.6% (p=.32). increase both IKDC scores seen every timepoint preoperative levels. any time point increased from 51.7 90.3 2-year follow-up. 53.1 preoperatively 88.4 49.8 pre op 90.6 53 91.9, 54.8 89.4 51.9 92.6 follow-up respectively. (14.3%, 2.1% 1.8% respectively). Residual 36.5% 14.9% 19.6% groups, identified Return sport (RTS) 80% returning grafts, 81% 86% grafts. high-risk faster RTS (8.6 months) groups; however, did not shorter return (10.7 months 11.7 group). contralateral tears, arthrofibrosis infection. Conclusions: decreases shifts greater reconstruction. do improve outcome alone. HA+LET; which athlete able play. conclusion, should undergo added autograft.