Combined Anterolateral and Anterior Cruciate Ligament Reconstruction Improves Pivot Shift and Anterior Tibial Translation With Similar Outcomes Compared With Isolated Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

To compare the subjective measurement indicators between isolated anterior cruciate ligament reconstruction (ACLR) and combined ACLR with anterolateral ligament reconstruction (ALLR) in patients with anterior cruciate ligament injuries. The Ovid MEDLINE and the Cochrane Central Registry of Controlled Trials were searched for randomized controlled trials with a level of evidence I-II published until September 2024 that evaluated subjective and safety outcomes between ACLR+ALLR and isolated ACLR. The Cochrane Risk of Bias 2.0 tool was used to evaluate publication bias. After literature reviews, 5 randomized controlled trials were identified. The follow-up data were obtained for 377 patients; 184 underwent isolated ACLR, and 193 underwent ACLR+ALLR. The patients who achieved pivot shift test grade I or more after surgery were reported in all 5 studies, and it was significantly lower in the ACLR+ALLR group compared with the isolated ACLR group (risk ratio 0.47, 95% confidence interval 0.23-0.96, P = .04, I² = 20%). Moreover, the degree of anterior tibial translation after surgery was reported in 4 studies, and it was also significantly lower in the ACLR+ALLR group (mean difference: -0.65, 95% confidence interval -1.26 to -0.04, P = .04, I² = 83%). The operative and follow-up outcomes were similar between the 2 groups. Through a meta-analysis with level of evidence I-II and minimum 1-year follow-up data with similar outcomes, we proved that the combined ACLR+ALLR approach yielded superior residual laxity and pivot-shift test compared with isolated ACLR. Level II, meta-analysis of Level I and II randomized controlled trials.