Arthroscopy - 2026-06-28 - Journal Article
Lateral Extra-articular Procedure Augmentation Is Associated With an Increased Risk of Arthrofibrosis Following Anterior Cruciate Ligament Reconstruction.
Varady NH, Parise S, Inclan PM, Kunze KN, Ranawat AS, Williams RJ
Topics
Key Takeaway
ACLR + LEAP carries a 1.78× higher adjusted risk of arthrofibrosis requiring MUA or lysis of adhesions compared to isolated ACLR (3.3% vs 1.8% at 2 years, HR 1.78, 95% CI 1.16–2.71).
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Summary
This study used the PearlDiver national insurance database to compare arthrofibrosis rates requiring intervention between ACLR+LEAP and isolated ACLR from 2015–2023. ACLR+LEAP was associated with significantly higher arthrofibrosis rates at 6 months (2.6% vs 1.2%), 1 year (3.1% vs 1.6%), and 2 years (3.3% vs 1.8%), with an adjusted HR of 1.78 after controlling for age, sex, meniscal repair, obesity, smoking, and comorbidities. ACLR+LEAP simultaneously demonstrated significantly lower revision rates at both 2 and 5 years, framing a clear risk-benefit tradeoff.
Key Limitation
Claims-based cohort cannot confirm graft type, tunnel placement, rehabilitation protocol, or the specific LEAP technique performed (LET vs. ALL reconstruction), all of which independently influence stiffness risk and confound the primary outcome.
Original Abstract
PURPOSE
To leverage the power of a large national sample to assess the risk of arthrofibrosis following anterior cruciate ligament reconstruction (ACLR) + lateral extra-articular procedure (LEAP) augmentation compared with ACLR alone.
METHODS
Patients who underwent either primary ACLR + LEAP or ACLR alone from October 2015 to April 2023 were identified from a large national insurance database (PearlDiver). Demographic data, surgical information, and comorbidities were collected. The primary outcome was arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions at 6 months. Time-to-event analyses were utilized to compare groups. Secondary outcomes included 90-day medical complications and 2- and 5-year ACLR revision rates.
RESULTS
There were 102,757 patients (860 ACLR + LEAP, 101,897 ACLR alone) with an average follow-up of 3.7 years. Patients undergoing ACLR + LEAP had a significantly increased risk of arthrofibrosis requiring intervention at 6 months (2.6% vs 1.2%, P < .001), 1 year (3.1% vs 1.6%, P < .001), and 2 years (3.3% vs 1.8%, P < .001) compared with patients undergoing isolated ACLR. These results were held in an adjusted analysis controlling for age, sex, concomitant meniscal repair, obesity, smoking, and comorbidities (hazard ratio 1.78, 95% confidence interval 1.16-2.71, P = .007). There were no significant differences in wound, thromboembolic, or other 90-day medical complications (P > .05 for all), whereas ACLR + LEAP was associated with significantly lower ACLR revision rates at 2 and 5 years (P ≤ .003 for both).
CONCLUSIONS
The addition of a LEAP to primary ACLR was associated with an increased risk of developing arthrofibrosis compared with ACLR alone. Importantly, differences were relatively small (absolute risk difference ~1.4 percentage points at 6 months), and LEAPs remain an important tool for reducing ACLR revision rates in many patients.
LEVEL OF EVIDENCE
Level III, retrospective comparative cohort study.