Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction with Lateral Extra-Articular Tenodesis in Bangladeshi Patients: A Prospective Study

Abstract

Background: Anterior cruciate ligament (ACL) injury is one of the most common causes of knee instability among young and physically active individuals. Although arthroscopic ACL reconstruction is the standard treatment, some patients continue to experience residual rotational instability. The addition of lateral extra-articular tenodesis (LET) has been proposed to enhance rotational stability and reduce graft failure. However, clinical evidence regarding the effectiveness of this combined procedure in Bangladeshi patients remains limited.
Objective: To evaluate the clinical stability and functional outcomes of anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis in Bangladeshi patients.
Methods: This prospective observational study was conducted from January 2023 to December 2025 at Enam Medical College Hospital, Comfort Hospital, and Micare Hospital, Dhaka. A total of 64 patients with ACL injuries who underwent arthroscopic ACL reconstruction with LET were included. Baseline demographic data, injury characteristics, and operative details were recorded. Clinical stability was assessed using Lachman test, pivot shift test, and anterior drawer test. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Lysholm knee score, Tegner activity scale, and Visual Analogue Scale (VAS) for pain. Patients were followed up for 12 months postoperatively, and preoperative and postoperative outcomes were compared.
Results: The mean age of the participants was 27.1 ± 6.2 years, with a predominance of males (71.9%). Sports injury was the most common mechanism of trauma (46.9%). Significant improvements in knee stability were observed after surgery. Positive Lachman test decreased from 100% preoperatively to 8.6%, while pivot shift and anterior drawer tests decreased from 81.3% and 87.5% to 6.9% and 10.3%, respectively (p < 0.001). Functional outcomes improved markedly, with the mean IKDC score increasing from 45.8 ± 8.4 preoperatively to 89.2 ± 5.7 at 12 months, and the Lysholm score improving from 51.9 ± 10.5 to 92.4 ± 5.2 (p < 0.001). Pain levels decreased significantly, with VAS scores declining from 6.3 ± 1.5 to 1.5 ± 0.9. Approximately 90.6% of patients returned to daily activities, and 71.9% resumed sports participation. Postoperative complications were relatively low, with residual instability observed in 6.3% and graft failure in 3.1% of patients.
Conclusion: ACL reconstruction combined with lateral extra-articular tenodesis provides significant improvement in knee stability, functional outcomes, and pain reduction in Bangladeshi patients. The procedure demonstrated a high rate of return to activity and a low complication rate, suggesting that the addition of LET may enhance surgical outcomes in selected ACL-injured patients.

J Shaheed Suhrawardy Med Coll 2025; 17(1): 9-15