KSSTA - 2026-03-07 - Journal Article
Faster return to work and reduced failure rates with the addition of a lateral extra-articular procedure in revision anterior cruciate ligament reconstruction among workers' compensation patients.
Olivieri R, Brunaud I, Rojas R, Martínez D, Laso JI, Pineda T, Franulic N
Topics
Key Takeaway
Adding a lateral extra-articular procedure to revision ACL reconstruction in workers' compensation patients reduced graft re-rupture from 33.3% to 5.9% and shortened time to RTW by 124 days.
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Summary
This retrospective cohort compared revision ACL reconstruction with versus without a lateral extra-articular procedure (LEAP) in workers' compensation patients, assessing RTW metrics, re-rupture rates, complications, and PROMs. LEAP significantly reduced graft re-rupture (5.9% vs. 33.3%, p=0.005) and time to RTW (167.8 vs. 291.5 days, p<0.001). Lysholm and KOOS scores were equivalent between groups, and complication rates were identical (6 events each, p=0.810).
Key Limitation
The small sample size (n=64) and retrospective design preclude controlling for index graft type, revision graft selection, and degree of rotational instability—all of which independently influence re-rupture risk and RTW.
Original Abstract
PURPOSE
This study aimed to compare occupational and clinical outcomes, including return-to-work (RTW) metrics, graft failure rates, complications and functional outcomes using patient-reported outcome measures (PROMs), in workers' compensation patients undergoing revision anterior cruciate ligament (ACL) reconstruction with or without the addition of a lateral extra-articular procedure (LEAP).
METHODS
A retrospective cohort study was conducted on workers over 18 years old who underwent first-time revision ACL reconstruction, with or without LEAP, between January 2016 and December 2022, with a minimum follow-up of 2 years. All graft types and LEAP techniques were included, as well as associated meniscal procedures. Outcomes assessed included workload classification according to the REFA (Reichsausschuss für Arbeitszeitermittlung) system, RTW rate and time to RTW, graft re-rupture, complications and PROMs (Lysholm and Knee Osteoarthritis Outcome Score [KOOS]). Functional outcomes were evaluated only in patients without graft failure. Statistical analyses included t-tests, Mann-Whitney U-tests and chi-square tests.
RESULTS
Sixty-four patients met the inclusion criteria (30 non-LEAP, 34 LEAP). RTW to the same work duties was comparable between groups (70% vs. 85.2%, p = 0.14); however, time to RTW was significantly shorter in the LEAP group (167.8 ± 80.9 vs. 291.5 ± 183.6 days; p < 0.001). The graft re-rupture rate was significantly lower with LEAP (5.9% vs. 33.3%; p = 0.005). PROMs showed no significant differences between groups in Lysholm or KOOS scores. Complication rates were low and comparable (six events in each group; p = 0.810), with no LEAP-related increase.
CONCLUSIONS
In workers' compensation patients undergoing revision ACL reconstruction, adding a LEAP significantly accelerates RTW and reduces graft failure without increasing complications, supporting its role as a valuable adjunct in this population.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.