Age-specific over-the-top anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) in skeletally immature patients: No major complications during early follow-up.

Abstract

To assess the rate of early complications and reoperation after anterior cruciate ligament reconstruction (ACLR) using an over-the-top technique with lateral extra-articular tenodesis (LET) in skeletally immature patients. This prospective case series included all skeletally immature patients undergoing ACLR with an over-the-top technique and LET augmentation between June 2022 and August 2025, performed by a single surgeon. Tibial tunnel strategy (extra-physeal, supra-physeal or trans-physeal) was selected based on remaining growth. Skeletal immaturity was defined by the presence of open physes on knee magnetic resonance imaging. All patients had a minimum follow-up of 9 months. The primary outcome was the rate of complications and reoperations within the first 9 post-operative months, selected to capture events occurring during the rehabilitation phase prior to return to sport. Secondary outcomes included patient characteristics, sports activity, surgical technique and associated meniscal injuries. Eighty-four patients (mean age 14.7 ± 1.7 years; 77% male) were included, with a mean follow-up of 20.0 ± 9.7 months. Surgical techniques included extra-physeal (12%), supra-physeal (48%) and trans-physeal (40%) approaches. Concomitant meniscal lesions were treated in 71 patients. No major complications were observed. Minor complications occurred in 20.2% of patients, with similar rates across techniques. The most common events were transient stiffness (9.5%), early swelling/fever (8.3%), delayed wound healing (7.4%) and hardware irritation (2.4%). Reoperations occurred in 4.7% of cases, all before return to sport, and included hardware removal, wound debridement and joint lavage. No deep infections or septic arthritis were reported. ACLR using an over-the-top technique with LET in skeletally immature patients was not associated with major complications during the early postoperative period. Minor complications were observed in approximately one-fifth of patients and were generally self-limiting or managed without long-term consequences. Longer follow-up is required to evaluate growth-related outcomes and graft survivorship. Level IV, case series.