AJSM - 2026-06-01 - Journal Article; Systematic Review; Meta-Analysis
Lateral Extra-articular Tenodesis With Anterior Cruciate Ligament Reconstruction in Pediatric and Skeletally Immature Patients: A Systematic Review and Meta-analysis.
Kotipalli S, Haidl T, Vivekanantha P, de Sa D, Kay J
Topics
Key Takeaway
ACLR+LET in pediatric and skeletally immature patients yields a graft rerupture rate of 0.8% versus 12.6% for isolated ACLR (OR=0.12; p=0.0036) with only 0.63% rate of physeal disturbance.
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Summary
This systematic review and meta-analysis evaluated clinical outcomes and complications of LET as an adjunct to ACLR in patients under 18 years, including a skeletally immature subgroup (n=204, mean age 13.6 years). Pooled rerupture rates were 1.6% (general pediatric) and 2.4% (skeletally immature), with comparative data showing ACLR+LET significantly outperforming isolated ACLR on both rerupture (0.8% vs 12.6%, OR=0.12) and RTS (92.4% vs 80.5%, OR=3.06). Growth disturbance occurred in 2 patients (0.63%), one requiring epiphysiodesis.
Key Limitation
The comparative analysis is underpowered and derived from non-randomized, retrospective Level IV studies, meaning selection bias in who received LET versus isolated ACLR cannot be excluded.
Original Abstract
BACKGROUND
Lateral extra-articular tenodesis (LET), alongside anterior cruciate ligament reconstruction (ACLR), has been shown to improve rerupture and rotational laxity in patients <25 years. However, safety and efficacy in both general pediatric (<18 years) and skeletally immature patients are important to identify.
PURPOSE
To assess clinical outcomes and complications after the LET procedure with ACLR in the pediatric and skeletally immature population.
STUDY DESIGN
Meta-analysis; Level of evidence, 4.
METHODS
Three databases were searched on December 5, 2024. Data were collected on study characteristics, demographics, surgical details, LET indications, patient-reported outcome measures, return to sport (RTS), rerupture rates, and complications. A meta-analysis of graft rerupture and RTS was performed using a Mantel-Haenszel and fixed-effects model (pooled effect measure: odds ratio [OR] with 95% CI).
RESULTS
Nine studies comprising 317 patients (318 knees) were included, of whom 204 patients (205 knees) were skeletally immature. The mean age of all patients and skeletally immature patients was 14.6 years (range, 8-18 years) and 13.6 years (range, 8-16.1 years), respectively. Common indications for LET included a grade 2+ pivot shift and intention to return to a high level of sport. The pooled RTS rate of ACLR+LET was 96% (92%-99%; I 2 = 48%) and 98% (94%-100%; I 2 = 39%) in general pediatric and skeletally immature patients, respectively. The rerupture rate after ACLR+LET was 1.6% and 2.4% in general pediatric and skeletally immature patients, respectively. Pooled data consisting of 119 patients who underwent ACLR+LET and 87 patients with isolated ACLR found ACLR+LET to have a significantly lower rate of ACLR graft reruptures compared with isolated ACLR of 0.8% and 12.6%, respectively ( I 2 = 0%; OR = 0.12; 95% CI, 0.03-0.53; P = .0036). ACLR+LET was also found to have a significantly higher RTS rate compared with isolated ACLR (92.4% vs 80.5%, respectively) ( I 2 = 0%; OR, 3.06; 95% CI, 1.3-7.18; P = .0104). There were 2 reports of growth disturbances (0.63%), with 1 case being corrected by surgical epiphysiodesis and another being clinically asymptomatic.
CONCLUSION
The LET procedure, as an adjunct to ACLR in pediatric and adolescent patients, has been shown to be safe with low complication rates-including physeal disturbance. Pooled data from the literature to date demonstrate that ACLR combined with an LET has a lower rate of graft rerupture while maintaining previously described high rates of RTS in pediatric patients compared with isolated ACLR.