Evidence map›Paper›PMID 41972212›Full record

ArticleJournal of the Pediatric Orthopaedic Society of North America2026

Lateral Extraarticular Procedures Increase Risk of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in Adolescents: A Multi-institutional Propensity-matched Study.

Christopher D Hamad, Joshua Wiener, Soroush Shahamatdar, Timothy Liu, David C Kaelber, Nicholas M Bernthal, William L Sheppard, Richard Bowen, Mauricio Silva, Soroush Baghdadi

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Article in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Christopher D HamadDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Joshua WienerDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Soroush ShahamatdarDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Timothy LiuDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
David C KaelberPopulation and Quantitative Health Sciences, Case Western Reserve University and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland OH, USA.
Nicholas M BernthalDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
William L SheppardDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Richard BowenDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Mauricio SilvaDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Soroush BaghdadiDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Loss of range of motion following anterior cruciate ligament reconstruction (ACLR) is a clinically significant complication that may lead to delayed recovery, arthrofibrosis, and secondary procedures. Lateral extraarticular procedures (LEAPs) are increasingly performed to reduce anterolateral instability and minimize graft failure but their impact on postoperative stiffness and arthrofibrosis remains unclear. Methods: The TriNetX Research Network was queried for patients aged 12-21 years who underwent primary ACLR between 2015 and 2023, with or without concomitant LEAP. Patients with inflammatory arthropathies were excluded. Propensity score matching was performed based on demographics and comorbidities, resulting in 2 balanced cohorts (n = 1,140 each). Outcomes within 1 year included arthrofibrosis, manipulation under anesthesia or lysis of adhesions (MUA/LOA), physical therapy (PT) utilization, opioid prescriptions, and chronic knee pain. Risk ratios (RRs), odds ratios (ORs), 95% confidence intervals (CIs), and Kaplan-Meier survival estimates were calculated. Results: Arthrofibrosis occurred in 5.7% of patients undergoing ACLR with LEAP compared with 2.8% of those undergoing isolated ACLR (RR: 2.02, OR: 2.08, 95% CI: 1.35-3.20, Conclusions: In this large, multi-institutional cohort, the addition of LEAP to ACLR in adolescents was associated with an increased risk of arthrofibrosis, as well as greater PT and opioid utilization at 1 year. While this is a database study with unmeasured variables and cannot definitively prove causation, surgeons should balance graft protection benefits with the higher risk of postoperative stiffness and emphasize careful patient selection, counseling, and early rehabilitation to reduce complications. Key Concepts: (1)The addition of lateral extraarticular procedures is associated with a 2-fold increase in arthrofibrosis compared with isolated anterior cruciate ligament (ACL) reconstruction.(2)Lateral extraarticular procedure (LEAP) patients demonstrate increased early resource utilization, including physical therapy and opioid prescriptions.(3)Increased postoperative pain and delayed range of motion may contribute to stiffness after LEAP procedures.(4)Surgeons should counsel patients on the graft-protective benefits of LEAP in the context of increased knee stiffness risk.(5)Careful patient selection and early range-of-motion-focused rehabilitation are essential when performing LEAP in adolescent ACL surgery. Level of Evidence: III; Retrospective Cohort Study.

Indexed as

ACLAdolescentArthrofibrosisLateral extraarticular tenodesisLEAP

Identifiers

PMID41972212
PMCPMC13068799

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.