To evaluate the clinical efficacy of extra-articular tendon fixation in patients with anterior cruciate ligament (ACL) injury combined with severe axial shift on postoperative joint function and stability.

Retrospectively, 164 patients with anterior cruciate ligament (ACL) injury complicated with severe pivot shift phenomenon (Grade Ⅲ pivot shift test) admitted to the First Department of Joint Surgery, Tangshan Second Hospital from January 2020 to June 2023 were enrolled in the study, including 104 males and 60 females, aged 20 to 45 years with a mean age of (28.8±5.1) years, having a disease course of 1 to 8 weeks with an average of (4.0±1.4) weeks. Among them, 86 cases suffered from left knee injury and 78 cases from right knee injury, with 67 cases complicated with meniscus injury. The patients were divided into two groups according to the surgical method adopted: the combined group (82 cases) treated with extra-articular tendon fixation combined with ACL reconstruction, and the control group (82 cases) treated with ACL reconstruction alone.

A total of 162 patients were successfully followed up at last, with a follow-up rate of 98.78%. The follow-up period ranged from 22.5 to 25.5 months, with a mean of (24.0±1.5) months. Specifically, 81 patients in the combined group were actually followed up, with a follow-up period of 22.5 to 25.3 months and a mean of (23.9±1.6) months; 81 patients in the simple group were actually followed up, with a follow-up period of 22.6 to 25.5 months and a mean of (24.1±1.4) months. At 6 months and 1 year postoperatively, the negative rates of pivot shift test and Lachman test, Lysholm scores and IKDC scores in the combined group were significantly higher than those in the simple group; at 2 years postoperatively, the excellent and good rate of grafts in the combined group was significantly higher than that in the simple group (P<0.05). The specific values were as follows: at 6 months postoperatively, the negative rate of pivot shift test and Lachman test in the combined group was 93.8% (76/81) and 96.3% (78/81) respectively, with the Lysholm score of (78.5±6.3) points and IKDC score of (76.8±5.7) points; while the corresponding indicators in the simple group were 72.8% (59/81), 76.5% (62/81), (70.2±5.9) points and (68.3±6.2) points respectively. At 1 year postoperatively, the negative rate of pivot shift test and Lachman test in the combined group was 98.8% (80/81) and 100.0% (81/81) respectively, with the Lysholm score of (85.7±4.8) points and IKDC score of (84.2±4.5) points; the corresponding indicators in the simple group were 80.2% (65/81), 83.9% (68/81), (76.3±5.5) points and (73.5±5.9) points respectively. At 2 years postoperatively, the excellent and good rate of grafts (Grade 0-Ⅰ) in the combined group was 97.5% (79/81), which was significantly higher than 81.5% (66/81) in the simple group (P<0.05).

Extra-articular tendon fixation combined with ACL reconstruction can effectively improve postoperative joint stability and function in patients with ACL injury and severe axial displacement, protect the graft, and demonstrate good safety.