Exploring Return To Play Functional Test Metrics After Combined ACL Reconstruction And Lateral Augmentation

Lateral augmentation (LA), anterolateral ligament reconstruction or lateral extra-articular tenodesis, has been adopted as a complementary procedure in young patients undergoing ACL reconstruction. Early research suggests favorable patient reported outcomes and reinjury rates. However, it is largely unknown where and how LA might impact functional outcomes, specifically within a return to play (RTP) rehab process in the pediatric population. PURPOSE: To explore and compare functional performance metrics between LA and matched isolated ACL reconstructed (ISO) pediatric patients during RTP rehab. METHODS: An IRB approved ACL registry was reviewed for pediatric patients treated with LA and ISO who completed post-op functional testing as part of a single institution’s RTP process. Patients with a lower extremity secondary diagnosis or previous procedure were excluded. Patients were 1:1 matched as closely as possible for age, biological sex, sport, time since surgery, meniscal involvement, and post-op rehab plan. The standard battery of RTP functional tests included: Y-Balance Lower Quarter, isokinetic dynamometry, single leg broad and triple jump, and single leg counter movement jump over force plates to gather landing phase metrics. Paired t-tests were used to evaluate group differences with statistical significance set at p < 0.05. RESULTS: No significant differences existed in demographics (LA: n = 15, aged 15.8 ± 1.4 years (p = 0.355), time since surgery 8.1 ± 2.3 months (p = 0.398); ISO n = 15, aged 15.3 ± 1.7 years, time since surgery 7.8 ± 2.1 months). No significant differences existed between groups for Y-Balance, quadriceps/hamstring strength, or jump metrics (p > 0.05). Large effect sizes were revealed for injured leg Y-Balance composite score (LA: 93.8 ± 8.8%, ISO: 91.2 ± 7.5%, Cohen’s d = 1.03) and triple jump distance (LA: 463 ± 98.4 cm, ISO: 368 ± 75.5 cm, Cohen’s d = 1.21). CONCLUSIONS: Current data may suggest that LA patients demonstrate no significant difference in ACL-RTP functional test performance compared to ISO patients. Large effect sizes in functional tests that placed multi-planar demand on the knee could indicate that challenging tests (deceleration/change of direction) and advanced technology (3D motion capture/bi-plane fluoroscopy) may be required to detect the functional impact of LA.