Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis: national utilization patterns and...

Lateral Extra-Articular Tenodesis (LET) is increasingly performed in conjunction with anterior cruciate ligament reconstruction (ACLR) to provide improved rotational knee stability. This study seeks to assess national utilization trends, revision rates, and complication profiles for primary ACLR vs ACLR with LET in a large national database.

A retrospective study of patients undergoing primary ACLR with or without LET in the PearlDiver database was performed. Multivariate analysis was performed to identify predictors of LET performance. ACLR-only and ACLR/LET patients were then propensity matched for age, sex, and comorbidity burden. 2-year postoperative outcomes including revision-ACLR, meniscus surgery, lysis of adhesion (LOA), manipulation under anesthesia (MUA), and total knee arthroplasty (TKA) were compared between groups.

Of 140,866 primary ACLR analyzed, 1,814 (1.3 %) had LET, with LET utilization increasing five-fold from 0.6 % in 2015 to 3.7 % in 2023. Younger age, male sex, meniscal repair and hypermobility were associated with increased odds of LET performance, while meniscectomy use was associated with decreased odds. There were no significant differences in rates of revision ACLR (ACLR/LET: 4.8 % vs ACLR: 3.6 %; p = 0.207), meniscus surgery, LOA, MUA, or TKA between the ACLR and ACLR with LET groups at 2-year follow-up.

The utilization of concomitant LET with ACLR is increasing nationally; however, in this large cohort, the addition of LET was not associated with lower revision rates or increased complications at 2-year follow-up. Further prospective study with granular clinical data, patient-reported outcomes, and longer follow-up is needed to assess the potential benefits of combined ACLR/LET procedures.