Background: Lateral extra-articular procedures (LEAPs) – such as the modified Lemaire lateral extra-articular tenodesis (LET) – can reduce the risk of graft failure after ACL reconstruction in adolescents. Because of this, the LET and similar procedures have been gaining popularity in the field of pediatric ACL reconstruction. However, it is unclear whether the use of such procedures increases risks of complications such as arthrofibrosis after ACL reconstruction using hamstring autograft in adolescents. Objectives: Adolescents treated with ACL reconstruction using hamstring autograft with and without modified Lemaire LET will exhibit similar rates of arthrofibrosis after surgery. Methods: This was a retrospective cohort study evaluating cases of ACL reconstruction using hamstring autograft performed by the senior author January 1, 2012 to May 20, 2024 in patients aged 10-19 years. Baseline patient variables were recorded, as were surgical variables – including meniscal repair or meniscectomy, inclusion of LET, and femoral socket drilling method. Complications requiring return to the operating room (RTOR) were identified. Causes for RTOR were noted, including arthrofibrosis, which was defined as a range-of-motion deficit of ≥5deg extension or ≥15deg flexion requiring lysis of adhesions and manipulation under anesthesia (LOA & MUA) within 1 year of surgery. Results: 569 cases were included. Arthrofibrosis rates were similar for patients who underwent hamstring autograft ACL reconstruction with LET (1.2% 0.03-6.4%) versus those without LET (3.7% 2.2-5.8%). Hamstring ACL reconstruction without LET was associated with a higher rate of revision ACL reconstruction for graft failure (5.8% vs 0%, p=0.01), although follow-up was longer in the isolated ACL reconstruction group. Conclusion: The addition of LET to hamstring ACL reconstruction in adolescent patients did not increase the risk of arthrofibrosis in this study. This work adds to the growing mass of literature supporting the safety and efficacy of this procedure in the setting of ACL reconstruction.
DeFrancesco et al. (Mon,) studied this question.