O2059: Addition of Lateral Extra-articular Tenodesis at Time of ACL Reconstruction Resulted in Similar Return to Sports Without Increasing Pain Scores in Pediatric and Adolescent Patients

Background: Anterior cruciate ligament (ACL) injuries are common in the pediatric and adolescent populations, and evidence suggests that the rate of graft rupture is higher than in adults. Concomitant anterolateral ligament (ALL) lateral extra-articular tenodesis (LET) at the time of ACL reconstruction has been shown to reduce the risk of graft rupture in adults, but there are limited studies in the pediatric population. Indications for performing an LET vary by surgeon but may include graft rupture, ligamentous laxity, and patient participation in year-round, pivoting sports. The objective of this study is to compare the presentation of patients treated with ACL reconstruction with and without LET, as well as to compare early patient reported outcomes between these two groups.

Methods: An IRB approved retrospective chart review was performed in patients younger than 18 years treated with either ACL reconstruction alone (CPT code 29888) or combined with an ALL lateral extra-articular tenodesis (LET) (identified with CPT code 27427). ACL alone patients were identified between the years 2018 and 2020, and ACL+LET patients were identified from the years 2017 to 2020. Patients with congenital ACL deficiency were excluded.
Variables recorded included demographic information, surgical information including graft types, and clinical characteristics including injury mechanism, ligamentous laxity, time to sports clearance, and PROMIS data. Descriptive statistics were calculated using Microsoft Excel. Bivariate statistics were calculated using Chi-squared or t-tests as appropriate.

Results: Seventy-five patients (48.0% female, median age 15) were identified who had ACL reconstructions with LET, and 365 were identified who had ACL reconstructions alone (44.1% female, median age 15). The Beighton score for the ACL+LET group (median=4; IQR=2-6) was significantly greater than that of the ACL alone group (median=2, IQR=0-2) (p < 0.05).
ACL+LET procedures were more commonly performed in revision surgery (18/75 patients; 24.0%) than were ACL only procedures (8/365 patients; 2.2%) (p < 0.05). At 3-6 months, PROMIS Physical Function Mobility scores were similar between groups, with an average of 39.2 in the ACL+LET group and 38.8 in the ACL alone group (p=0.80). PROMIS Pain Interference scores were lower in the ACL+LET group (p < 0.05). Clearance to sports was at an average of 11.6 ± 3.4 months for the ACL alone group and 11.5 ± 2.2 months for the ACL+LET group (p=0.86).

Conclusion: Combined ACL reconstruction with LET may reduce risk of ACL re-rupture in pediatric and adolescent patients, but indications regarding when to offer both procedures have not been fully delineated. This study suggests that greater ligamentous laxity, as measured by Beighton score, as well as the patient requiring a revision reconstruction, may make surgeons treating pediatric patients more likely to offer both procedures. Furthermore, this study suggests that the addition of LET resulted in similar sport clearance times and postoperative mobility in this group.