24. L’ajout d’une plastie extra-articulaire à la reconstruction du LCA réduit significativement les taux de rupture de greffe : Étude rétrospective comparative de skieurs alpins professionnels de l’équipe de France.

Elite Alpine ski 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 1980’s.

Elite skiers from the french ski team who had undergone ACL reconstruction, with or without a lateral extra-articular procedure (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 by interrogation of the database, medical notes review and a final telemedicine interview. A multivariate analysis using the penalized Cox model was performed to explore the relationship between the graft rupture, surgical procedure type and any potential explanatory variables.

Among 81 ACLR procedures analyzed, 50 were performed in an isolated manner (isolated ACLR group) and 31 were combined with a LEAP (ACLR+LEAP group), which was performed using either modified Lemaire or anterolateral ligament reconstruction (ALLR). Graft rupture rates were 34.0% in the isolated ACLR group and 6.5% in the ACLR+LEAP group. Multivariate analysis demonstrated that adding a lateral extra-articular procedure significantly reduced the risk of ACL graft rupture when compared to isolated ALCR (Hazard Ratio (HR) = 5.286, IC 95% [1.068 ; 26.149], P = .0412). Age (HR = 1.114, P = .1157), Gender (HR = 1.573, P = .3743) and ACL graft Type (HR = 1.417, P = .5394) were not found to be significant risk factors.

Combined ACLR and lateral extra-articular procedures confer a significant 5.3 times reduction in the rate of ACL graft rupture in elite alpine ski athletes. Those treated with isolated ACLR remain at extremely high risk of second ACL injury.