Abstract
Background:
In recent years, surgeons have increasingly incorporated lateral extra-articular tenodesis (LET) into pediatric anterior cruciate ligament (ACL) reconstruction in an effort to reduce retear rates. Since 2023, we have been performing LET in conjunction with all ACL reconstructions at our center. This study aimed to evaluate whether universal LET increases the risk of arthrofibrosis in children and adolescents undergoing primary ACL reconstruction.
Hypothesis:
We hypothesized that the universal addition of LET to primary pediatric ACL reconstruction increases the risk of arthrofibrosis within the first three months following surgery.
Methods:
We conducted a retrospective review of all patients who underwent ACL reconstruction at a single center between 2019 and 2025. Patients aged ≤18 years at the time of surgery with at least six months of follow-up were included. Exclusion criteria were revision ACL surgery and Micheli-Kocher physeal sparing procedures. Demographic data, graft type, and concomitant procedures, including meniscal repair or debridement and LET, were collected. All LET procedures were performed using a modified Lemaire technique, and were added to all primary procedures since 2023. Follow-up visits were reviewed for patients who developed arthrofibrosis, defined as a loss of >5 degrees of extension or >15 degrees of flexion at three months postoperatively. Logistic regression was used to evaluate risk factors associated with arthrofibrosis.
Results:
A total of 350 patients met inclusion criteria, with a mean age of 16.5 years (range, 12.5 – 18) at the time of surgery. Quadriceps tendon autografts were used in 70.4% of patients (n=286), and bone–patellar tendon–bone (BTB) autografts in 15.8% (n=64). Meniscal repair and/or debridement was performed in 33.7% of cases (n=118), and LET was performed in 47.1% (n=165). The overall incidence of arthrofibrosis was 3.4% (n=12). In multivariable logistic regression, LET was the only variable significantly associated with arthrofibrosis (odds ratio 14.0, p = 0.01). Age at surgery, sex, and meniscal procedures were not significantly associated with arthrofibrosis (Figure 1).
Conclusion:
The universal addition of LET to primary ACL reconstruction in pediatric patients was associated with a significantly increased risk of arthrofibrosis, while age, sex, and concomitant meniscal procedures were not. These findings support a more individualized approach to LET rather than its routine use in all cases, balancing short-term risks with potential long-term benefits through shared decision-making with the patient and family.
