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
ARTICLE HIGHLIGHTS
Research background

Anterior cruciate ligament (ACL) reconstruction surgery has shown excellent outcomes, however the restoration of rotational stability remains limited. The role of the reconstruction of the lateral soft tissue restraints or the supplement of the ACL reconstruction with a lateral extra-articular tenodesis have gain popularity and they are now routinely procedures following an ACL reconstruction.

Research motivation

The research motivation of this systematic review and meta-analysis was to clarify how ACL reconstruction surgery combined with lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR) can improve rotational stability and how this can prevent possible failure and instability symptoms.

Research objectives

The aim of this review article was to compare the clinical effectiveness of ACL reconstruction surgery combined with LET or ALLR to ACLR alone.

Research methods

A systematic review to include all the studies investigation either or both of LET and ALLR was conducted. A literature search was carried out on 4 databases for studies from 2000 to November 2021. All studies included in this review were independently appraised by two authors. The critical appraisal was conducted by the Critical Appraisal Skills Programme. Statistical analysis was performed on the collected data.

Research results

Thirteen studies compared ACLR to ACLR + LET. The remaining eleven were studies which compared ACLR to ACLR + ALLR.The nine studies that could be used in analysis encompassed 961 knees. Six of the nine studies demonstrated a statistically significant difference in pivot shift test scores between ACLR only patient groups and ACLR + AEAP patient groups.

Research conclusions

This systematic review has demonstrated that the 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.

Research perspectives

A randomized controlled trial comparing the two techniques would be of value for clarifying which technique would give the better outcomes regarding the rotational stability following an ACL reconstruction surgery.