An isolated lateral extra-articular procedure for persisting rotatory instability following ACL reconstruction has low failure rates with good clinical and patient-reported outcomes: A systematic review and meta-analysis.
systematic_review · Level I
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- Also identified by DOI 10.1002/ksa.70373.
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Abstract
The purpose of this systematic review was to evaluate the clinical and patient-reported outcomes of an isolated lateral extra-articular procedure (LEAP) performed to address persistent rotatory instability following a previous isolated anterior cruciate ligament reconstruction (ACLR) in the absence of complete graft rupture. A literature search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on an isolated LEAP performed to address instability after a standalone ACLR, without a complete graft tear, were included. Pre-operative factors analysed included time from index ACLR, graft type, graft status and tunnel position, associated meniscal tears and grade of pivot shift. Pre- and post-operative patient-reported outcome measures (PROMs), and post-operative clinical outcomes (including the grade of residual pivot shift) were also analysed. The rate of subsequent complete graft rupture or persisting instability was noted. Five studies with a total of 74 knees were included. These comprised 42 males and 32 females with an age range of 17-41 years and mean follow-up of 25.5 ± 6.9 (12-30) months. There was a statistically significant improvement in pivot shift grade distribution from pre-operative (27 Grade 1, 16 Grade 2 and 9 Grade 3) to post-operative (8 Grade 1, 0 Grade 2 and 0 Grade 3) (χ<sup>2</sup> test, p < 0.001). A random effects meta-analysis showed a statistically significant improvement between pre- and post-operative values for International Knee Documentation Committee (IKDC), Lysholm and Tegner Activity Scores. The pooled rate of complete graft rupture or persisting instability was 5.4% (0%-10.5%). An isolated LEAP is an effective procedure with good clinical and patient-reported outcomes and low failure rates for patients with persisting rotatory instability after a previous ACL reconstruction. Level IV.