Lateral extra-articular tenodesis preserves quadriceps strength without significantly affecting plyometric performance after anterior cruciate ligament reconstruction.

Abstract

To investigate whether adding lateral extra-articular tenodesis to anterior cruciate ligament reconstruction affects quadriceps strength or reactive strength at 6-8 months postoperatively in young, high-risk athletes. This retrospective cohort study analysed patients who underwent primary anterior cruciate ligament reconstruction with or without lateral extra-articular tenodesis between 2015 and 2019. All surgeries were performed using hamstring tendon autografts by a single surgeon. Patients completed standardised isokinetic and 3D biomechanical testing between 6 and 8 months postoperatively. Quadriceps strength was assessed using isokinetic dynamometry, with results expressed as peak torque relative to body weight and limb symmetry index. Reactive strength was measured through double-leg and single-leg drop jump tests in a motion analysis laboratory. The reactive strength index was calculated by dividing jump height by ground contact time. Group comparisons were performed using independent t-tests or Mann-Whitney <i>U</i> tests, with significance set at <i>p</i> < 0.05. Sixty-eight patients were included: 39 underwent anterior cruciate ligament reconstruction with lateral extra-articular tenodesis and 29 underwent isolated anterior cruciate ligament reconstruction. Quadriceps strength was similar between groups for both limbs and for limb symmetry index. Reactive strength values were lower in the lateral extra-articular tenodesis group, but the differences were not statistically significant. A non-significant trend toward lower reactive strength was observed in lateral extra-articular tenodesis patients under 18 years of age. Lateral extra-articular tenodesis does not impair quadriceps strength recovery at 6-8 months following anterior cruciate ligament reconstruction. While reactive strength trended lower in these patients, the difference was not statistically significant. Further investigation is warranted to clarify its clinical relevance. Level III.