Rates of Arthrofibrosis in Adolescent Patients After ACL Reconstruction Using Hamstring Autograft With or Without Lateral Extra-articular Tenodesis

Abstract

Background:

Lateral extra-articular tenodesis (LET) can reduce the risk of graft failure after anterior cruciate ligament (ACL) reconstruction in adolescents and young adults. It is unclear whether the use of this procedure increases risks of complications such as arthrofibrosis after ACL reconstruction using hamstring autograft in adolescents.

Hypothesis:

Adolescents treated with ACL reconstruction using hamstring autograft with and without modified Lemaire LET have similar rates of arthrofibrosis after surgery.

Study Design:

Retrospective cohort study; Level of evidence, 3.

Methods:

Cases of ACL reconstruction using hamstring autograft performed by the senior author from January 1, 2012, to May 20, 2024, in patients aged 10 to 19 years were retrospectively reviewed. LET was not used before 2022 but was routinely used after 2022 based on accruing evidence supporting it. 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 ≥5° of extension or ≥15° of flexion requiring lysis of adhesions and manipulation under anesthesia within 1 year of surgery.

Results:

A total of 569 cases were included. Arthrofibrosis rates were similar for patients who underwent hamstring autograft ACL reconstruction with LET (1.2%; 95% CI, 0.03%-6.4%) versus those without LET (3.7%; 95% CI, 2.2%-5.8%) (P = .34).

Conclusion:

The rate of arthrofibrosis requiring surgical intervention after hamstring ACL reconstruction is low (<6.5%). The addition of LET to hamstring ACL reconstruction in adolescent patients did not increase the risk of arthrofibrosis in this study.