Does the Anterolateral Tenodesis Really Influence the ACL Maturation Process?

There is ongoing controversy regarding whether the addition of anterolateral tenodesis (ALT) affects the maturation process of anterior cruciate ligament (ACL) grafts. Some authors argue that patients undergoing ACL reconstruction with ALT demonstrate delayed graft maturation on magnetic resonance imaging (MRI), while others report no improvement or delay in graft maturation with the addition of ALT. The aim of this study was to analyze whether the addition of ALT affects ACL graft maturation and to evaluate interobserver agreement in MRI analysis, given the lack of consensus in the literature. The study provides a retrospective cohort study. This study included 168 patients: 117 underwent isolated ACL reconstruction, and 51 underwent ACL reconstruction with associated ALT between 2018 and 2021. Radiological evaluation was performed to assess graft maturation and integration. Two orthopedic surgeons and two radiologists independently assessed MRI findings to determine interobserver variability. Radiological evaluation showed no significant differences between groups in the Howell ligamentization scale (p > 0.5) or signal-to-noise quotient. Similarly, there were no differences in tendon-bone healing at the fibrous interzone (p > 0.5). Interobserver evaluation revealed only slight agreement between the four observers. The addition of ALT to ACL reconstruction does not affect ACL graft maturation as assessed by MRI. ALT is a common adjunct to ACL reconstruction. Given the current uncertainty, this study contributes to the understanding of its impact-or lack thereof-on graft maturation.