La tenodesis extraarticular lateral reduce la falla del injerto tras la revisión del ligamento cruzado anterior sin comprometer el retorno al deporte ni los resultados funcionales
DOI:
https://doi.org/10.63403/re.v33i2.500Palabras clave:
Ligamento Cruzado Anterior, Tenodesis Extraarticular Lateral, Retorno al Deporte, Fallo Plastia LCA, Resultados funcionalesResumen
Introducción: la revisión de reconstrucción del ligamento cruzado anterior (RLCA) es un procedimiento complejo, asociado a peores resultados y mayor tasa de falla del injerto que la reconstrucción primaria. Debido a que la inestabilidad rotatoria residual puede aumentar la carga sobre el injerto, la tenodesis extraarticular lateral (TEA) ha surgido como un complemento para mejorar el control rotatorio y reducir potencialmente la rerrotura. Sin embargo, su impacto sobre desenlaces centrados en el paciente, especialmente el retorno al deporte, sigue siendo incierto.
Objetivos: evaluar el impacto de la TEA sobre la falla del injerto, los resultados funcionales y el retorno al deporte en pacientes sometidos a revisión de RLCA.
Materiales y métodos: se realizó un estudio de cohorte retrospectivo comparativo. Se incluyeron pacientes esqueléticamente maduros sometidos a una primera revisión de RLCA entre 2014 y 2020, con seguimiento mínimo de 4 años. Se analizaron 113 pacientes: 53 tratados con revisión aislada y 60 con revisión asociada a TEA. El desenlace primario fue el retorno al deporte, definido como reinicio de cualquier actividad deportiva, registrándose además el retorno al nivel prelesional. Los desenlaces secundarios incluyeron tiempo hasta el retorno deportivo, IKDC subjetivo, Tegner y falla del injerto.
Resultados: la edad y seguimiento promedio fue 27.1 ± 8.0 años y 6.0 años, respectivamente. Los resultados funcionales fueron comparables entre grupos: IKDC 80.4 ± 9.2 vs. 84.1 ± 8.8; p = 0.86, y Tegner 6.6 ± 1.3 vs. 6.7 ± 1.2; p = 0.92. En total, 68 pacientes (60 %) retornaron a alguna actividad deportiva y 45 (40 %) al nivel prelesional. Aunque el retorno fue mayor en el grupo con TEA, la diferencia no fue estadísticamente significativa (p = 0.41). La falla del injerto fue menor con TEA (3 % vs. 19 %; p = 0.03), asociándose a menor riesgo de rerrotura (OR 0.15; IC 95 %: 0.03-0.72).
Conclusiones: en la revisión de RLCA, la adición de TEA se asoció con menor riesgo de rerrotura, sin diferencias significativas en retorno al deporte ni resultados funcionales.
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Derechos de autor 2026 Waldo Gonzalez, Jorge Isla, Alfredo Sandoval, Minerva Itriago, David Figueroa
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
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