Lateral Extra-Articular Tenodesis With Iliotibial Band in ACL Autograft Reconstruction for Female Soccer Athletes With Generalized Ligamentous Laxity Yields Graft Failure and Return-to-Sport Rates Comparable to 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 higher 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 two years of follow-up, was conducted. Participants were divided into two groups: those who received ACLR alone and those who received ACLR with LET. Generalized ligamentous laxity (GLL) was defined as a Beighton score ≥4 and was not considered an indication for LET. ACL autografts included the quadriceps, bone patellar tendon bone, and hamstrings in both groups. Patient demographics and physical exam findings, including pivot shift results, were collected. Positive pivot-shift refers to a grade ≥ 2. Patient outcomes included graft failure (defined as ACL re-tear), International Knee Documentation Committee (IKDC) score, Lysholm score, return to sport, and complications. Independent t-tests, chi-squared tests, and Mann-Whitney U tests were conducted to compare outcomes between the two groups. Minimally Clinical Important Difference (MCID) 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 that 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 higher GLL rate (48.8% vs. 18.9%; P<0.001) and greater median Beighton score (3.0 vs. 1.0; P<0.001) than those without LET. There was a similar rate of graft failure in patients who underwent LET compared to the control group (4.7% vs. 3.0%; P=0.658). Based on MCID thresholds, there were no clinically relevant differences in IKDC or Lysholm scores noted between the two groups. Return-to-sport rates were also comparable between the LET and control cohorts (90.7% vs. 85.6%; P=0.807) CONCLUSIONS: The addition of LET during ACLR in female soccer players with preoperative generalized ligamentous laxity yields graft re-tear and return-to-sport rates comparable to those of athletes without ligamentous laxity.

Level of evidence: III - retrospective comparative study.