Lateral Extra-Articular Tenodesis Does Not Impact Postural Stability After Pediatric Anterior Cruciate Ligament Reconstruction with Hamstrings Tendons

Background and Objectives: Given the high rates of anterior cruciate ligament graft rupture in the pediatric population, lateral extra-articular tenodesis (LET) is increasingly used in combination with anterior cruciate ligament reconstruction (ACLR) to mitigate the risk of re-injury. This study aimed to compare postoperative postural stability between patients undergoing ACLR with and without LET. It was hypothesized that postural stability would be comparable between patients with and without LET. Materials and Methods: This retrospective, single-center, double-surgeon case–control study included patients who underwent primary ACLR using hamstring tendon autografts between January 2022 and May 2025. Postoperative postural stability was assessed using the Biodex Stability System (BSS) global stability index (GSI), which was the primary outcome of interest. Demographic and surgical data were collected as well as all postoperative GSIs. GSI comparisons between the LET and no-LET groups were made at ≤6 months and >6 months postoperatively. Secondary analysis compared GSI differences between the healthy and operated legs. Results: Among 229 patients screened, 100 met the inclusion criteria (median age, 16 years [IQR, 15–17]); 65 underwent LET and 35 did not, and 54 were female (54%). The groups were comparable on demographic and surgical data (p-value: n.s.). No operated leg GSI difference was observed between the LET and no-LET groups at ≤6 months (p = 0.372) and >6 months postoperatively (p = 0.424). Patients with LET had significantly better (lower) healthy leg GSIs (Mean ± SD; 2.7 ± 0.9) than no-LET patients (3.9 ± 1.8) at >6 months postoperatively (p = 0.004). At ≤6 months, patients showed better GSIs on their operated limb (Median [IQR]; 2.6 [2.1–3.9]) compared to the healthy limb (3.5 [2.3–4.6]) (p = 0.003). This difference disappeared at the latest follow-up. Conclusions: The addition of LET concomitant with ACLR was not associated with a significant difference in postural stability, as assessed by the GSI from the BSS. However, given the sample size and study limitations, these findings should be interpreted with caution. Increased attention to the healthy limb during ACLR rehabilitation may be warranted, particularly in the early postoperative period (<6 months). Further studies with larger cohorts are needed to confirm these observations.