Lateral Extra-articular Tenodesis in High-risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Clinical Results at Minimum Follow-up of 2 Years.

Abstract

Lateral extra-articular tenodesis (LET) has gained popularity as a supplementary method for ACL reconstruction (ACL-R) to reduce the risk of graft rupture in adults. However, information on the effectiveness and safety of this procedure in pediatric and adolescent patients remains limited. This study aimed to evaluate the functional outcomes and complications of lateral extra-articular tenodesis associated with ACL-R in adolescents at a minimum follow-up of 2 years. A consecutive series of patients aged ≤18 years who underwent ACL-R + LET in a 6-year period was retrospectively analyzed. Outcome measures included participants' return to sports, complications, concomitant or subsequent surgical procedures, and patient-reported outcome measures such as the Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and HSS Functional Activity Brief Scale (HSS Pedi-FABS). Forty-two patients were included in the final analysis. The mean follow-up duration was 41 months, with a mean patient age of 16.1 ± 2 years (range: 13 to 18 y); 81% were male. Thirty-nine patients (93%) participated in organized sports such as soccer, rugby, or volleyball. Autologous hamstring tendon grafts were used in 100% of cases. At a mean follow-up of 41 months (range: 24 to 66 mo), the median SANE, Pedi-IKDC, and HSS-Pedi FABS scores were 89.1, 94.3, and 26.7 points, respectively. A 100% successful return to sport (RTS) was observed at a mean of 10.2 months, with 89.7% of patients returning to their preinjury or a higher level of sport. Three patients (7%) underwent additional ipsilateral knee surgical procedures, comprising 2 meniscal surgeries and one arthroscopic lysis of adhesions. No graft injuries were observed during the study period. The findings of this study suggest that ACL-R associated with LET in high-risk adolescent patients is associated with favorable patient-reported outcomes, a high return to sports, and a low rate of complications, including graft rupture, at an average follow-up of 3.5 years. Case series. Level IV.