Clinical and Biomechanical Outcomes of Anterior Cruciate Ligament (ACL) Reconstruction Associated With Lateral Extra-articular Tenodesis (LET)

KYRA is a non-invasive outpatient device that allows the assessment of dynamic laxity during the pivot shift phenomenon. The device enables highly precise quantification of the degree of laxity. The unit of measurement is millimeters per second squared.

The KT-1000 is an objective assessment tool that measures anterior tibial translation relative to the position of the femur by applying a predefined force that pushes the tibia forward. It is commonly used in research settings to quantitatively evaluate static anteroposterior knee laxity following anterior cruciate ligament reconstruction surgeries.

A standard physical examination will be performed, including palpation, assessment of joint mobility, and laxity. During palpation, the typical tender points related to meniscal pathology are examined: the joint line areas on their anterior, middle, and posterior aspects. Pain is recorded as either present or absent. Joint mobility is assessed by asking the patient to flex and extend the knee, measuring the angle formed in degrees (0-130), with attention to the presence or absence of any joint clicks or catches. Laxity is evaluated using the classic tests: anterior drawer test, Lachman test, and pivot shift test.

This test allows evaluation of the anterior translation of the tibia relative to the femur with the knee flexed at 90 degrees. An increased translation suggests a lesion of the reconstructed ACL (neo-ACL). The degree of translation is quantified on a scale from 0 to 3.

This test allows evaluation of the anterior translation of the tibia relative to the femur with the knee flexed at 30 degrees. An increased translation suggests a lesion of the reconstructed ACL (neo-ACL). It is quantified on a scale from 0 to 3.

This is a clinical maneuver used to assess rotational instability of the knee under examination. The test is performed by applying an internal rotation, valgus stress, and knee flexion; the occurrence of a tibial "clunk" or shift suggests a lesion of the reconstructed ACL (neo-ACL) associated with rotational instability. It is quantified on a scale from 0 to 3.

The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a self-administered questionnaire used to evaluate both short- and long-term outcomes after a knee injury. It assesses five dimensions: pain, symptoms, activities of daily living, sports and recreational function, and knee-related quality of life.

Each dimension is scored separately using a 5-point Likert scale ranging from 0 (no problems) to 4 (extreme problems). Scores for each dimension are summed and then transformed to a 0-100 scale, where 0 represents extreme knee problems and 100 indicates no knee problems. The KOOS meets essential standards for outcome measures and is useful for monitoring the progression of knee injuries and the effectiveness of treatments.

The Lysholm Knee Score is a validated measurement scale that evaluates knee function through 8 items, allowing assessment of the knee's condition in relation to the functional demands of daily activities. This assessment tool is used to evaluate surgical outcomes in patients operated on for ligament or meniscal injuries of the knee. The final score is obtained by summing the scores from the different items and ranges from 0 to 100. Scores are categorized into subgroups: Excellent (95-100), Good (84-94), Fair (65-83), and Poor (<64).

The VAS is a unidimensional quantitative numerical scale for pain assessment ranging from 0 to 10. The patient selects the number that best describes the intensity of their pain at that moment. A score of 0 means no pain, and 10 indicates the worst possible pain.

The Tegner Score estimates a person's level of physical activity on a scale from 0 to 10, where 0 represents "disability" and 10 represents participation in competitive sports, such as national or international-level soccer. This score is the most widely used to define the physical activity level of patients with knee disorders. In the study, the Tegner Score will be completed directly by the examiner through an interview with the patient.

Any complications and subsequent interventions will be documented and recorded in the Case Report Form (CRF). The staff responsible for distributing and collecting the questionnaires will assign an identification code on the questionnaire cover page to protect the privacy of the study participants.