Published online Jul 18, 2022. doi: 10.5312/wjo.v13.i7.662
Peer-review started: December 27, 2021
First decision: April 6, 2022
Revised: April 13, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 18, 2022
Processing time: 202 Days and 8.3 Hours
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).
To compare the clinical outcomes following ACL reconstruction (ACLR) alone or ACLR with either LET or ALLR.
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.
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 Commi
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.
Core Tip: Either lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR) should be utilized with anterior cruciate ligament (ACL) reconstruction (ACLR) in patients with rotational instability, to confer greater stability. Either technique, together with ACLR, leads to superior mechanical outcomes, in comparison to ACLR alone. Both techniques reduce risk of ACL re-rupture, compared to isolated ACLR, with ALLR having lower rates than LET.