The addition of lateral extraarticular tenodesis does not significantly affect the pain or confidence levels after anterior cruciate ligament reconstruction in adolescent athletes.

Abstract

Anterior cruciate ligament reconstruction (ACLR) in adolescents poses a unique challenge due to their high rates of re-injury and increased participation in high-risk sports. The addition of a Lateral Extra-Articular Tenodesis (LET) has gained popularity in augmenting ACLR in high-risk cases. However, its effect on patient-reported outcome measures (PROMs), specifically regarding pain and psychological readiness, remains unclear in adolescent populations. This study aimed to assess whether the addition of LET influences postoperative pain and confidence levels following ACLR. We hypothesized that the addition of LET may increase pain, delay early recovery and thereby perhaps reduce confidence levels in adolescents undergoing ACLR. A retrospective matched cohort analysis was performed, including 238 adolescent patients who underwent ACLR, with 79 receiving additional LET and 159 undergoing isolated ACLR. All patients underwent ACLR using hamstring tendon autografts. The groups were matched based on age, gender and Body-mass-index (BMI). International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale were collected pre-operatively and at 9 months post-operatively. Psychological readiness was assessed using the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score at 6 months post-operatively. The primary outcome was the change in PROMs from baseline, compared between groups using appropriate statistical tests. Both groups demonstrated significant improvement in PROMs from pre-operative scores to 9-month follow-up. When comparing the two groups, improvement in IKDC, Lysholm and Tegner scores was not statistically significant between the LET and no-LET groups. There was no statistically significant difference in 6-month ACL-RSI scores between the LET and no-LET groups. The findings suggest that the addition of LET does not significantly alter short-term pain and confidence levels in adolescents following ACLR LEVEL OF EVIDENCE: Level III.