Comparative outcomes of anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis: A meta-analysis.

Abstract

Purpose: Rotational instability, post-operative high-grade pivot shifts and graft re-rupture are areas of debate in anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) techniques can control rotational laxity and reduce re-rupture by strengthening the anterolateral knee. Over-constraint and early-onset osteoarthritis are documented sequelae. This review compares the clinical, functional and patient-reported outcomes of ACLR with and without LET.

Methods: Studies on the comparative outcomes of ACLR with and without LET were identified. All clinical, functional and patient-reported outcomes were extracted. The quality of each study was assessed. Random-effects model was then used to obtain pooled estimates of procedural differences for each outcome if they were reported by three or more studies.

Results: Twenty-seven studies and 3225 patients were included. ACR with LET conferred statistically significant better laxity reduction through KT1000 testing with pooled RR estimate of 0.83 (95% confidence interval [CI], 0.73-0.95) and a better side-side comparison of anterior tibial translation with pooled WMD estimate of 0.61 (95% CI, 0.22-0.99). LET further lowered rates of graft failure/re-rupture with a pooled RR estimate of 0.93 (95% CI, 0.90-0.95). There was no significant difference in time taken for return to sports with a pooled WMD estimate of 0.00 (95% CI, -1.80 -1.80) or in subjective patient-reported outcome measures such as IKDC subjective score with a pooled WMD estimate of -0.75 (95% CI, -2.18 to 0.68), Lysholm score with a pooled WMD estimate of -1.73 (95% CI, -4.12 to 0.67), or Tegner activity index with a pooled WMD estimate of -0.55 (95% CI, -1.11 to 0.02). Osteoarthritic data was not assessed in this review due to the lack of data.

Conclusion: LET addition confers better clinical outcomes over isolated ACLR. However, there is no significant difference between functional outcomes regarding returning to sports or subjective patient-reported outcome measures.

Level of evidence: Level II.