32. LIVE from AAOS with Dr. Brian Waterman: Is LET + ACLR the Future of Sports Medicine?

We’re coming to you live from the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting to take part. The educational program is comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters.

Over the next several episodes we’re going to be reviewing five sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Brian Waterman to get his take on these poster presentations.

Dr. Brian Waterman is a board-certified, orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration and joint preservation, complex knee surgery and shoulder and elbow care. He is the Chief of sports medicine at Wake Forest University and the Director of their sports medicine fellowship program. Dr. Waterman completed his orthopedic surgery residency at William Beaumont Army Medical Center and served 13 years in the U.S. Army, earning multiple honors including the Meritorious Service Medal and Army Commendation Medal.

Dr. Waterman then went on to complete a sports medicine fellowship at Rush University Medical Center in Chicago. He is the team physician for Wake Forest University, the Winston-Salem Dash, U.S. Ski and Snowboard and several local high schools.

Dr. Waterman is an associate editor for the Arthroscopy Journal and is on the Board of Directors for Arthroscopy Association of North America. Given his extensive experience with orthopedic research, Dr. Waterman led the sports medicine poster tour at AAOS this year, so we’re looking forward to getting his unique perspective on these poster presentations.

Featured Poster:
Pediatric Anterior Cruciate Ligament Reconstruction: Adding Lateral Extra-Articular Tenodesis Resulted in Similar Return to Sport without Increasing Pain Scores.

Ted Ganley and his colleagues at CHOP performed a retrospective chart review to determine first: clinical factors that motivate surgeons to perform a lateral extraarticular tenodesis or “LET” at the time of ACL reconstruction; and second: to compare early clinical outcomes between patients who underwent an ACLR alone versus ACLR with LET.

We did our first Overtime episode on LET back in November of 2021. So if you’d like to learn more about this procedure including the indications and clinical outcomes, go listen to that episode. Briefly, the addition of an extraarticular stabilization procedure such as LET or ALL reconstruction has been shown to reduce the risk of graft rupture in adults, but there are limited studies in the pediatric population.

The authors found that the Beighton score for the ACL+LET group was significantly greater than that of the ACL alone group. Second, LET procedures were more commonly performed in revision surgery rather than primary ACL reconstruction. This study suggests that greater ligamentous laxity, as measured by Beighton score, as well as the patient requiring a revision ACL reconstruction, may make surgeons treating pediatric patients more likely to offer LET or ALL reconstruction. Lastly, this study suggests that the addition of LET resulted in similar pain levels, sport clearance times and post-op mobility compared to ACL reconstruction alone.