Comparative outcomes of anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis: A meta-analysis.

Abstract

Rotational instability, post-operative high-grade pivot shifts and graft re-rupture are areas of debate in anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) techniques can control rotational laxity and reduce re-rupture by strengthening the anterolateral knee. Over-constraint and early-onset osteoarthritis are documented sequelae. This review compares the clinical, functional and patient-reported outcomes of ACLR with and without LET. Studies on the comparative outcomes of ACLR with and without LET were identified. All clinical, functional and patient-reported outcomes were extracted. The quality of each study was assessed. Random-effects model was then used to obtain pooled estimates of procedural differences for each outcome if they were reported by three or more studies. Twenty-seven studies and 3225 patients were included. ACR with LET conferred statistically significant better laxity reduction through KT1000 testing with pooled RR estimate of 0.83 (95% confidence interval [CI], 0.73-0.95) and a better side-side comparison of anterior tibial translation with pooled WMD estimate of 0.61 (95% CI, 0.22-0.99). LET further lowered rates of graft failure/re-rupture with a pooled RR estimate of 0.93 (95% CI, 0.90-0.95). There was no significant difference in time taken for return to sports with a pooled WMD estimate of 0.00 (95% CI, -1.80 -1.80) or in subjective patient-reported outcome measures such as IKDC subjective score with a pooled WMD estimate of -0.75 (95% CI, -2.18 to 0.68), Lysholm score with a pooled WMD estimate of -1.73 (95% CI, -4.12 to 0.67), or Tegner activity index with a pooled WMD estimate of -0.55 (95% CI, -1.11 to 0.02). Osteoarthritic data was not assessed in this review due to the lack of data. LET addition confers better clinical outcomes over isolated ACLR. However, there is no significant difference between functional outcomes regarding returning to sports or subjective patient-reported outcome measures. Level II.