Lateral Extra‐articular Procedure Augmentation Is Associated With an Increased Risk of Arthrofibrosis Following Anterior Cruciate Ligament Reconstruction

PURPOSE: To leverage the power of a large national sample to assess the risk of arthrofibrosis following anterior cruciate ligament reconstruction (ACLR) + lateral extra-articular procedure (LEAP) augmentation compared with ACLR alone. METHODS: Patients who underwent either primary ACLR + LEAP or ACLR alone from October 2015 to April 2023 were identified from a large national insurance database (PearlDiver). Demographic data, surgical information, and comorbidities were collected. The primary outcome was arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions at 6 months. Time-to-event analyses were utilized to compare groups. Secondary outcomes included 90-day medical complications and 2- and 5-year ACLR revision rates. RESULTS: There were 102,757 patients (860 ACLR + LEAP, 101,897 ACLR alone) with an average follow-up of 3.7 years. Patients undergoing ACLR + LEAP had a significantly increased risk of arthrofibrosis requiring intervention at 6 months (2.6% vs 1.2%, P < .001), 1 year (3.1% vs 1.6%, P < .001), and 2 years (3.3% vs 1.8%, P < .001) compared with patients undergoing isolated ACLR. These results were held in an adjusted analysis controlling for age, sex, concomitant meniscal repair, obesity, smoking, and comorbidities (hazard ratio 1.78, 95% confidence interval 1.16-2.71, P = .007). There were no significant differences in wound, thromboembolic, or other 90-day medical complications (P > .05 for all), whereas ACLR + LEAP was associated with significantly lower ACLR revision rates at 2 and 5 years (P ≤ .003 for both). CONCLUSIONS: The addition of a LEAP to primary ACLR was associated with an increased risk of developing arthrofibrosis compared with ACLR alone. Importantly, differences were relatively small (absolute risk difference ~1.4 percentage points at 6 months), and LEAPs remain an important tool for reducing ACLR revision rates in many patients. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.