Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2022; 13(7): 662-675
Published online Jul 18, 2022. 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, Jaibaji Monketh, Andrea Volpin
Nikhil Agarwal, Department of Trauma and Orthopaedics, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
Jaibaji Monketh, Health Education England North East, Newcastle Upon Tyne NE15 8NY, United Kingdom
Andrea Volpin, Department of Trauma and Orthopaedics, NHS Grampian, Elgin IV30 1SN, United Kingdom
Author contributions: Monketh J and Agarwal N analyzed the data and wrote the manuscript; Volpin A designed the research study and reviewed the manuscript; and All authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest or funding towards this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Volpin, MD, Surgeon, Department of Trauma and Orthopaedics, NHS Grampian, Pluscarden Rd, Elgin IV30 1SN, United Kingdom. andrea.volpin@nhs.scot
Received: December 27, 2021
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
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; Knee; Systematic review; Lateral extra tenodesis; Anterolateral ligament; Knee surgery

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.