Abstract
BACKGROUND:
The anterior cruciate ligament (ACL) is one of two primary ligaments responsible for providing stability to the knee joint. ACL rupture is a frequent occurrence in sports-related knee injuries. Persistent rotational instability following surgical reconstruction of the anterior cruciate ligament (ACLR) has presented a longstanding difficulty. Anterolateral extra-articular procedures (AEAP), including lateral extra-articular tenodesis (LET) or reconstruction of the anterolateral ligament (ALLR), have been employed to address this issue.
METHODS:
In this systematic review and meta-analysis, PubMed, ScienceDirect, and Cochrane databases were searched from inception to August 2023. Randomized Controlled Trials (RCTs) studies were included. The CONSORT criteria were used to assess the risk of bias. Using Review Manager ver. 5.4. The effect sizes were estimated as log risk ratios and SMDs with 95% confidence intervals (CIs).
RESULTS:
Of the 17 screened studies, 9 RCTs met the eligibility criteria for qualitative analysis; 7 were included in the meta-analysis. It was found that [OR = -1.56 (-2.02 to -1.06), P < 0.001)] in favor of ACLR+AEAP, this indicates that the incorporation of AEAP in ACLR leads to significantly improved pivot shift test results, thereby enhancing rotational stability. The comparison of pivot-shift alone in LET [OR = 0.40 (0.19-0.81), P < 0.0001] and ALLR [OR = 0.23 (0.11-0.47), P < 0.0001]. The comparison of adverse event rates in LET [OR = 2.34 (1.53-3.58), P < 0.0001] and ALLR [OR = 0.59 (0.36-0.95), P = 0.03].
CONCLUSIONS:
This meta-analysis has found that use of either LET or ALLR in addition to ACLR enhances mechanical results. Patients who received both additional procedures along with ACLR exhibited better pivot-shift grades than those who only had ACLR. Moreover, both combined approaches resulted in lower rates of ACL re-rupture compared to ACLR alone. Notably, ALLR also led to lower rates of ACL re-rupture compared to LET.