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Peer-reviewedCC BYOrthopaedic journal of sports medicine

The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction

  • Christopher D. Hamad1
  • Kole Joachim2
  • Esther Chung3
  • Shannon Wu1
  • Timothy Liu1
  • Mauricio Silva1,4
  • Richard Bowen1,4
  • Soroush Baghdadi1,4
4 affiliations
  1. 1Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
  2. 2David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
  3. 3The University of California Los Angeles, Los Angeles, California, USA
  4. 4Luskin Orthopaedic Institute for Children, Los Angeles, California, USA
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Abstract

Background:: Lateral extra-articular tenodesis (LET) is increasingly used to augment anterior cruciate ligament (ACL) reconstruction (ACLR) in pediatric patients to improve graft survival and rotational stability. However, concerns remain regarding postoperative knee stiffness after augmentation.

Purpose:: To determine whether LET augmentation is associated with increased risk of restricted knee range of motion (ROM) after pediatric ACLR and to identify patient and surgical factors associated with postoperative stiffness.

Study Design:: Case-control study; Level of evidence, 3.

Methods:: The authors reviewed 412 pediatric patients who underwent primary ACLR (2013-2025) at a single tertiary referral center. Restricted knee ROM was defined as a loss of flexion ≥15° or extension ≥5° at 3 months postoperatively compared with the contralateral limb. Exposures included LET utilization, demographic factors, socioeconomic measures (Area Deprivation Index and insurance status), graft characteristics, meniscal procedures, time to initiation of physical therapy, and time from injury to surgery. Multivariable logistic regression models were used to identify independent predictors of restricted knee ROM.

Results:: Restricted knee ROM occurred in 12.9% of procedures overall (16.8% with LET vs 10.2% without). LET was independently associated with increased odds of restricted motion (adjusted odds ratio [AOR] 2 [95% CI, 1.01-3.95]; P = .046). Female sex was associated with increased risk (AOR, 4.23 [95% CI, 2.09-8.55]; P < .001). Age at surgery, time to initiation of physical therapy, graft type, meniscal procedures, socioeconomic deprivation, insurance status, and time from injury to surgery were not independently associated with restricted knee ROM. Seven patients underwent manipulation under anesthesia, and 3 underwent lysis of adhesions. Overall, manipulation under anesthesia or lysis of adhesions was required in 8 patients and was more common after LET.

Conclusion:: LET augmentation during pediatric ACLR is associated with an increased risk of early restricted knee ROM, although most cases are mild and resolve with nonoperative management. Female sex represented an additional risk factor for postoperative stiffness.

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Cite

BibTeXRIS
BibTeX
@article{hamad2026impact,
  title = {{The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction}},
  author = {Christopher D. Hamad and Kole Joachim and Esther Chung and Shannon Wu and Timothy Liu and Mauricio Silva and Richard Bowen and Soroush Baghdadi},
  journal = {Orthopaedic journal of sports medicine},
  year = {2026},
  month = sep,
  doi = {10.1177/23259671261467539},
  url = {https://europepmc.org/article/PMC/PMC13724889},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction
AU  - Christopher D. Hamad
AU  - Kole Joachim
AU  - Esther Chung
AU  - Shannon Wu
AU  - Timothy Liu
AU  - Mauricio Silva
AU  - Richard Bowen
AU  - Soroush Baghdadi
PY  - 2026
DA  - 2026/09/01
JO  - Orthopaedic journal of sports medicine
DO  - 10.1177/23259671261467539
UR  - https://europepmc.org/article/PMC/PMC13724889
AB  - Background:: Lateral extra-articular tenodesis (LET) is increasingly used to augment anterior cruciate ligament (ACL) reconstruction (ACLR) in pediatric patients to improve graft survival and rotational stability. However, concerns remain regarding postoperative knee stiffness after augmentation.  Purpose:: To determine whether LET augmentation is associated with increased risk of restricted knee range of motion (ROM) after pediatric ACLR and to identify patient and surgical factors associated with postoperative stiffness.  Study Design:: Case-control study; Level of evidence, 3.  Methods:: The authors reviewed 412 pediatric patients who underwent primary ACLR (2013-2025) at a single tertiary referral center. Restricted knee ROM was defined as a loss of flexion ≥15° or extension ≥5° at 3 months postoperatively compared with the contralateral limb. Exposures included LET utilization, demographic factors, socioeconomic measures (Area Deprivation Index and insurance status), graft characteristics, meniscal procedures, time to initiation of physical therapy, and time from injury to surgery. Multivariable logistic regression models were used to identify independent predictors of restricted knee ROM.  Results:: Restricted knee ROM occurred in 12.9% of procedures overall (16.8% with LET vs 10.2% without). LET was independently associated with increased odds of restricted motion (adjusted odds ratio [AOR] 2 [95% CI, 1.01-3.95]; P = .046). Female sex was associated with increased risk (AOR, 4.23 [95% CI, 2.09-8.55]; P < .001). Age at surgery, time to initiation of physical therapy, graft type, meniscal procedures, socioeconomic deprivation, insurance status, and time from injury to surgery were not independently associated with restricted knee ROM. Seven patients underwent manipulation under anesthesia, and 3 underwent lysis of adhesions. Overall, manipulation under anesthesia or lysis of adhesions was required in 8 patients and was more common after LET.  Conclusion:: LET augmentation during pediatric ACLR is associated with an increased risk of early restricted knee ROM, although most cases are mild and resolve with nonoperative management. Female sex represented an additional risk factor for postoperative stiffness.
SN  - 2325-9671
ER  -