Lateral Extra-Articular Tenodesis With Iliotibial Band in Anterior Cruciate Ligament Autograft Reconstruction for Female Soccer Athletes With Generalized Ligamentous Laxity Yields Graft Failure and Return-to-Sport Rates Comparable With Athletes Without Generalized Laxity

Abstract

Purpose

To evaluate the effectiveness of adding lateral extra-articular tenodesis (LET) to primary anterior cruciate ligament reconstruction (ACLR) in competitive female soccer athletes with greater preoperative generalized ligamentous laxity.

Methods

A retrospective review of female high school and collegiate soccer players who underwent primary ACLR from 2013 to 2021, with a minimum of 2 years of follow-up, was conducted. Participants were divided into 2 groups: those who received ACLR alone and those who received ACLR with LET. Generalized ligamentous laxity was defined as a Beighton score ≥4 and was not considered an indication for LET. Anterior cruciate ligament (ACL) autografts included the quadriceps, bone−patellar tendon−bone, and hamstrings in both groups. Patient demographics and physical examination findings, including pivot shift results, were collected. Positive pivot-shift refers to a grade ≥2. Patient outcomes included graft failure (defined as ACL retear), International Knee Documentation Committee score, Lysholm score, return to sport, and complications. Independent t tests, χ² tests, and Mann-Whitney U tests were conducted to compare outcomes between the 2 groups. Minimally clinical important difference was calculated from preoperative to final follow-up.

Results

A total of 133 female soccer players who underwent ACLR met inclusion criteria, including 43 patients that received an ACLR + LET and 90 patients who underwent isolated ACLR. Average follow-up was 39.0 and 36.1 months in the LET group and the control group, respectively. Patients who underwent LET had a greater generalized ligamentous laxity rate (48.8% vs 18.9%; P < .001) and greater median Beighton score (3.0 vs 1.0; P < .001) than those without LET. There was a similar rate of graft failure in patients who underwent LET compared with the control group (4.7% vs 3.0%; P = .658). On the basis of minimally clinical important difference thresholds, there were no clinically relevant differences in International Knee Documentation Committee or Lysholm scores noted between the 2 groups. Return-to-sport rates also were comparable between the LET and control cohorts (90.7% vs 85.6%; P = .807).

Conclusions

The addition of LET during ACLR in female soccer players with preoperative generalized ligamentous laxity yields graft retear and return-to-sport rates comparable with those of athletes without ligamentous laxity.

Level of Evidence

Level III, retrospective comparative study.