Purpose To leverage the power of a large national sample to assess the risk of arthrofibrosis following anterior cruciate ligament reconstruction (ACLR) + lateral extra‐articular procedure (LEAP) augmentation compared with ACLR alone. Methods Patients who underwent either primary ACLR + LEAP or ACLR alone from October 2015 to April 2023 were identified from a large national insurance database (PearlDiver). Demographic data, surgical information, and comorbidities were collected. The primary outcome was arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions at 6 months. Time‐to‐event analyses were utilized to compare groups. Secondary outcomes included 90‐day medical complications and 2‐ and 5‐year ACLR revision rates. Results There were 102,757 patients (860 ACLR + LEAP, 101,897 ACLR alone) with an average follow‐up of 3.7 years. Patients undergoing ACLR + LEAP had a significantly increased risk of arthrofibrosis requiring intervention at 6 months (2.6% vs 1.2%, P .05 for all), whereas ACLR + LEAP was associated with significantly lower ACLR revision rates at 2 and 5 years ( P ≤ .003 for both). Conclusions The addition of a LEAP to primary ACLR was associated with an increased risk of developing arthrofibrosis compared with ACLR alone. Importantly, differences were relatively small (absolute risk difference ~1.4 percentage points at 6 months), and LEAPs remain an important tool for reducing ACLR revision rates in many patients. Level of Evidence Level III, retrospective comparative cohort study.
Varady et al. (Sun,) studied this question.