Clinical Outcomes of Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis Using the Coker-Arnold Technique: A Retrospective Case Series of 328 Patients With a 72-Month Follow-up

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Abstract
Background: Lateral extra-articular tenodesis (LET) combined with anterior cruciate ligament reconstruction (ACLR) has been shown to reduce graft failure. While the benefits of techniques such as the modified Lemaire procedure and anterolateral ligament reconstruction are well documented, the literature on other LET techniques is more limited. Purpose: To evaluate the clinical outcomes and risk factors for failure in patients undergoing ACLR combined with LET using the Coker-Arnold modification of the MacIntosh technique. Study Design: Case series; Level of evidence, 4. Methods: This retrospective case series included patients who underwent primary ACLR using a hamstring tendon autograft along with concurrent LET at a single institution between 2013 and 2022. Clinical evaluations included subjective outcome measures (International Knee Documentation Committee [IKDC] score, Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm score, and Tegner score) and objective KT-1000 arthrometer testing. Risk factors for graft failure were identified using multivariate logistic regression. Results: The final study cohort consisted of 328 patients. At a mean follow-up of 72.4 ± 30.3 months, 11 patients (3.4%) experienced graft failure. The mean side-to-side difference according to the KT-1000 arthrometer was 1.45 ± 1.04 mm. Patients showed excellent outcomes, with 91.5% achieving the patient acceptable symptom state (PASS) for the IKDC score and >90.0% achieving the PASS for all KOOS subscales, except for the Activities of Daily Living subscale (79.6%). High Tegner scores (≥8) and the presence of chondral lesions were independently associated with graft failure (odds ratio, 6.82 and 5.89, respectively; P < .01). Age, sex, pivot-shift grade, meniscal status, and timing of surgery were not predictive of failure. Conclusion: Combined ACLR and LET using the Coker-Arnold modification of the MacIntosh technique led to a 3.4% failure rate at a mean follow-up of >5 years. Higher Tegner scores and the presence of chondral lesions were found to be independently associated with reruptures.

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