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. 2022 Jul 18;13(7):662-675.
doi: 10.5312/wjo.v13.i7.662.

Clinical and mechanical outcomes in isolated anterior cruciate ligament reconstruction vs additional lateral extra-articular tenodesis or anterolateral ligament reconstruction

Nikhil Agarwal  1 , Jaibaji Monketh  2 , Andrea Volpin  3
Affiliations

Clinical and mechanical outcomes in isolated anterior cruciate ligament reconstruction vs additional lateral extra-articular tenodesis or anterolateral ligament reconstruction

Nikhil Agarwal et al. World J Orthop. .

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction has been a successful treatment for ACL rupture. However ongoing rotational instability can be an issue. Several surgical techniques have been recommended to overcome this including lateral extra-articular tenodesis (LET) and more recently anterolateral ligament reconstruction (ALLR).

Aim: To compare the clinical outcomes following ACL reconstruction (ACLR) alone or ACLR with either LET or ALLR.

Methods: A systematic review was conducted by means of four databases (MEDLINE, EMBASE, Cochrane and Clinical.Trials.Gov), and the Reference Citaion Analysis (https://www.referencecitationanalysis.com/) to identify all studies investigating either or both of LET and ALLR. The Critical Appraisal Skills Programme checklist for cohort studies was employed for critical appraisal and evaluation of all twenty-four studies which met the inclusion criteria.

Results: Pooled meta-analyses illustrated that ACLR with additional LET or ALLR results in improved pivot shift test scores, compared to isolated ACLR. There was no statistically significant difference in International Knee Documentation Committee (IKDC) clinical scores with addition of either LET or ALLR. ACL re-rupture rates were compared between LET and ALLR techniques. There was a statistically significant difference between techniques, with a 1.14% rupture rate in ACLR +ALLR, and 4.03% rupture rate in ACLR + LET. Isolated ACLR re-rupture rates were 12.59%, significantly higher than when augmented with either ALLR or LET (P < 0.0001 for both groups). There were no statistical differences in pivot shift test or IKDC scores between LET and ALLR techniques.

Conclusion: This meta-analysis has found that use of either LET or ALLR in addition to ACLR results in improved mechanical outcomes suggesting surgeons should consider augmenting ACLR with an extra-articular procedure in patients with rotatory instability. Furthermore, both anterolateral extra articular procedures in addition to ACLR lead to reduced ACL re-rupture rates compared to isolated ACLR. Moreover, ALLR results in reduced ACL re-rupture rates, compared to LET. More research is needed to compare the two respective extra-articular procedures.

Keywords: Anterior cruciate ligament; Anterolateral ligament; Knee; Knee surgery; Lateral extra tenodesis; Systematic review.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest or funding towards this manuscript.

Figures

Figure 1
Figure 1
Results from the comprehensive literature search.
Figure 2
Figure 2
Forest plot. A: The effect size of pivot shift test scores in patients who underwent anterolateral extra articular procedures (AEAP) in addition to anterior cruciate ligament reconstruction (ACLR), compared to ACLR alone. I2 = 47.192; B: The effect size of International Knee Documentation Committee scores in patients who underwent AEAP in addition to ACLR, compared to ACLR alone. I2 = 6.432e-6. RE: Random effects.
See this image and copyright information in PMC

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