Age-specific over-the-top anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) in skeletally immature patients: No major complications during early follow-up.

PURPOSE: To assess the rate of early complications and reoperation after anterior cruciate ligament reconstruction (ACLR) using an over-the-top technique with lateral extra-articular tenodesis (LET) in skeletally immature patients.

METHODS

This prospective case series included all skeletally immature patients undergoing ACLR with an over-the-top technique and LET augmentation between June 2022 and August 2025, performed by a single surgeon. Tibial tunnel strategy (extra-physeal, supra-physeal or trans-physeal) was selected based on remaining growth. Skeletal immaturity was defined by the presence of open physes on knee magnetic resonance imaging. All patients had a minimum follow-up of 9 months. The primary outcome was the rate of complications and reoperations within the first 9 post-operative months, selected to capture events occurring during the rehabilitation phase prior to return to sport. Secondary outcomes included patient characteristics, sports activity, surgical technique and associated meniscal injuries.

RESULTS

Eighty-four patients (mean age 14.7 ± 1.7 years; 77% male) were included, with a mean follow-up of 20.0 ± 9.7 months. Surgical techniques included extra-physeal (12%), supra-physeal (48%) and trans-physeal (40%) approaches. Concomitant meniscal lesions were treated in 71 patients. No major complications were observed. Minor complications occurred in 20.2% of patients, with similar rates across techniques. The most common events were transient stiffness (9.5%), early swelling/fever (8.3%), delayed wound healing (7.4%) and hardware irritation (2.4%). Reoperations occurred in 4.7% of cases, all before return to sport, and included hardware removal, wound debridement and joint lavage. No deep infections or septic arthritis were reported.

CONCLUSION

ACLR using an over-the-top technique with LET in skeletally immature patients was not associated with major complications during the early postoperative period. Minor complications were observed in approximately one-fifth of patients and were generally self-limiting or managed without long-term consequences. Longer follow-up is required to evaluate growth-related outcomes and graft survivorship.

LEVEL OF EVIDENCE: Level IV, case series.