Trends in Anterolateral Ligament Reconstruction and Lateral Extra-Articular Tenodesis in Children and Adolescents

Abstract

Background:Graft failure remains a challenging complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Anterolateral ligament reconstruction (ALLR) and lateral extra-articular tenodesis (LET) show promise in lowering the risk of ACL graft failure, but there is little data on surgeon practices and preferences in the pediatric population. An improved understanding can help determine the feasibility of future research, identify questions of interest, and ultimately design clinical studies.Hypothesis/Purpose:The purpose of this study is to quantify surgeon practices regarding ALLR and LET in children and adolescents.Methods:An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society. Surgeon and practice demographic information was collected. The survey then asked several questions about indications, preferences, and techniques for ALLR or LET in the context of primary and revision pediatric ACLR. Chi-square and Fisher exact tests were used to evaluate factors that impact surgical preferences.Results:A total of 63 surgeons completed the survey, of which 62% performed ≥50 pediatric ACLR annually. In the setting of primary ACLR, 35/63 (56%) sometimes perform ALLR or LET. The frequency increased to 50/63 (79%) with revision ACLR. The most common indications for ALLR/LET in the primary setting were high-grade pivot shift, knee hyperextension, generalized laxity, and type of sports participation. Surgeons whose practice was >75% sports medicine were more likely to perform ALLR/LET with both primary and revision ACLR (p=0.005 and <0.001, respectively). Those that completed a sports medicine fellowship were more likely to perform these procedures than those with only pediatric orthopaedic training in both primary (68% vs. 36%, p=0.01) and revision scenarios (92% vs. 60%, p=0.002). Of the 28 respondents that do not perform ALLR/LET with primary ACLR, 75% cited insufficient evidence as the reason. However, 95% of surgeons that do perform these procedures expressed interest in studying them prospectively and 86% were willing to randomize patients.Conclusion:In this study of pediatric sports surgeons, 56% sometimes perform ALLR or LET with primary ACLR and 79% with revision ACLR. Surgeons with sports medicine fellowship training or a mostly sports practice were more likely to perform these procedures. Insufficient evidence was the most common reason given by those that do not perform ALLR or LET. However, there was substantial willingness to prospectively study and even randomize pediatric patients to assess the impact of ALLR/LET in this population.