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Addition of a 2-Limb Lateral Extra-articular Procedure to Anterior Cruciate Ligament Reconstruction Does Not Increase
Samuel I Rosenberg1, Elizabeth H Merritt2, Neeraj M Patel3
1Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
Purpose:
To compare the rates and types of early complications in pediatric patients undergoing a 2-limb lateral extra-articular procedure (LEAP) alongside anterior cruciate ligament reconstruction (ACLR) versus ACLR alone.
Methods:
The records of patients who underwent primary ACLR at a single tertiary children's hospital were reviewed for this retrospective cohort study, excluding those with multiligament reconstructions, modified MacIntosh reconstructions, or less than 1-year follow-up. The 2-limb LEAP used a strip of iliotibial band autograft that remained attached at the Gerdy tubercle and was first fixed to the femur and then reflected distally and fixed to the tibia, resulting in 1 limb that was similar to the Lemaire tenodesis and another that reconstructed the anterolateral ligament. Demographic data, intraoperative findings and techniques, and postoperative complications were compared between patients who underwent ACLR with LEAP and those who underwent ACLR alone.
Results:
A total of 268 patients with a mean follow-up period of 2.0 ± 0.8 years were included in the analysis, of whom 49 (18%) underwent a 2-limb LEAP with ACLR. Most of the patients who underwent LEAP (91.8%) received a quadriceps tendon autograft for ACLR, whereas those who underwent only ACLR had a more equal distribution of quadriceps (38.8%), patella (34.2%), and hamstring (26.9%) tendon autografts. The most common short-term complication was persistent pain (i.e., pain lasting >3 months), occurring in 4.1% of patients with LEAP and 5.9% of those with ACLR alone (P > .99). There was no difference in the proportion of patients with arthrofibrosis (10.2% of those with LEAP vs 9.6% of those with ACLR alone, P = .90), superficial wound infection (2.0% with LEAP vs 3.7% with ACLR alone, P > .99), or reoperation for any reason (32.6% with LEAP vs 36.5% with ACLR alone, P = .78). The rate of postoperative cosmetic concerns was significantly different (6.1% of patients with LEAP vs 0.5% of patients with ACLR, P = .02).
Conclusions:
Children and adolescents undergoing a 2-limb LEAP with primary ACLR reported a higher rate of cosmetic concerns after surgery than those undergoing ACLR alone. However, the addition of the LEAP did not otherwise increase the risk of early postoperative complications at a minimum 1-year follow-up.
Level Of Evidence:
Level III, retrospective cohort study.
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