Combining ALL with ACL Reconstruction Improves Kinesiophobia and Pivot Shift Reducing Reoperation Rate When Stable Lateral Meniscal Tears Are Left In Situ.

Abstract

Introduction/objectives: Graft failure and secondary meniscal tears remain significant concerns following anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular procedures (LEAPs), including anterolateral ligament (ALL) reconstruction, have demonstrated efficacy in reducing ACL graft failure and meniscal repair rates. However, their impact on untreated stable meniscal tears remains unclear. This study aimed to compare clinical outcomes and reoperation rates between ACLR with and without ALL reconstruction in patients with untreated stable lateral meniscal tears.

Methods: A retrospective analysis of prospectively collected data was performed on patients who underwent primary ACLR with autograft hamstring tendon (HT) alone or HT combined with ALL reconstruction (HT + ALL) between January 2019 and December 2022. All included patients had a concomitant stable, not displaced or moving lateral meniscal tear left in situ. Clinical evaluation was conducted preoperatively and at a minimum follow-up of two years, utilizing the Lachman test, pivot shift test, Rolimeter measurements, Objective and subjective IKDC, Lysholm score, and the Tampa Scale for Kinesiophobia (TSK-11). Reoperation rates and postoperative complications were also recorded. A post-hoc power analysis was conducted based on the results of the independent samples t-test comparing kinesiophobia scores between the two groups.

Results: Sixty-four patients (average age at time of surgery: 28 years) with a minimum follow-up of 2 years (range: 2-5.5 years follow-up) were included: 31 in the HT group and 33 in the HT + ALL group. Graft rupture rates were 9.6% in the HT group and 3.3% in the HT + ALL group (not statistically significant difference). Secondary meniscal surgeries were required in 12.9% of HT patients compared to 0% in the HT + ALL group (p < 0.05). The HT + ALL group demonstrated lower reoperation rates at final follow-up (97% vs. 77.5%; p < 0.05). Functional scores showed no statistically significant differences except for improved TSK-11 scores (P<0.01) and pivot shift test (P<0.025) outcomes favoring the HT + ALL group.

Conclusions: In patients with stable lateral meniscal tears left in situ, adding ALL reconstruction to ACLR with autografts may reduce the risk of secondary meniscal surgery and graft failure, with comparable or improved functional outcomes.

Level of evidence: 3, retrospective comparative study.