Anterior Cruciate Ligament Reconstruction Alone Versus With Lateral Extra-articular Tenodesis With Minimum 2-Year Follow-up: A Meta-analysis and Systematic Review of Randomized Controlled Trials

Abstract

Background: Lateral extra-articular tenodesis (LEAT) aims to improve anterolateral stability of the injured knee during anterior cruciate ligament reconstruction (ACLR) surgery. Inconclusive evidence surrounding the efficacy and safety of LEAT has propelled clinical interest and ongoing discussions. Purpose: To establish level 1 evidence by assessing randomized controlled trials (RCTs) with minimum 2-year follow-up that directly compared ACLR with LEAT (LEAT group) and ACLR alone (non-LEAT group) in terms of clinical outcomes and complications. Study Design: Meta-analysis and systematic review; Level of evidence, 1. Methods: Meta-analysis was performed with a multidatabase search (Cochrane, EMBASE, OVID Medline, PubMed, and Web of Science) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on September 9, 2020. Data from published RCTs meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. Results: A total of 7 RCTs were included, consisting of 517 LEAT and 589 non-LEAT patients. Only autografts were used for ACLR and LEAT. A variety of LEAT techniques and autograft fixation methods were used. We found improved stability (residual positive pivot shift: risk ratio [RR], 0.59; 95% CI, 0.39-0.88; P = .01) and better clinical outcomes (International Knee Documentation Committee [IKDC] score: mean difference [MD], 2.31; 95% CI, 0.54-4.09; P = .01; and Lysholm score: MD, 2.71; 95% CI, 0.68-4.75; P = .009) in the LEAT than non-LEAT group. Graft rerupture rate was 3 times less likely (RR, 0.31; 95% CI, 0.17-0.58; P < .001) in the LEAT group than the non-LEAT group. Conclusion: Good-quality evidence is available to support the efficacy of LEAT in improving anterolateral knee stability and reducing graft reruptures in primary ACLR. LEAT should be considered in patients with high risk factors. Although Lysholm and IKDC scores were statistically better in the LEAT group, these are unlikely to be clinically significant. Future studies should aim to identify patient populations that would best benefit from LEAT with ACLR.

“Over-the-Top” Anterior Cruciate Ligament Reconstruction Associated With a Lateral Extra-Articular Tenodesis in Children

“… 7 , 16 , 17 For example, the LET seems to reduce ACL rerupture rate recurrence of these injuries. 18 , 19 …”

A Landmark-Based Technique for Determining an Isometric Femoral Attachment Site for Lateral Extraarticular Tenodesis is Inaccurate

“… 1 , 15 , 21 Although there have been concerns of knee overconstraint and subsequent osteoarthritis when LET is performed, 22 recent studies that have used contemporary techniques and controlled for meniscus and articular cartilage status have not demonstrated an increased risk of arthritis compared to ACLR alone. 23 Although biomechanical studies have established an IAA and radiographic safe isometric area for LET, 7 , 8 future clinical studies that specifically evaluate femoral fixation location during LET will be necessary to assess how this is associated with clinical outcomes.…”

Non-anatomical double-bundle anterior cruciate ligament reconstruction combined with modified lateral extra-articular tenodesis in high-grade pivot shift anterior cruciate ligament injury：A retrospective study

“…A meta-analysis by Onggo et al [27] showed that ACL reconstruction combined with LET could signi cantly reduce the positive rate of pivot shift and improve the subjective function score. Besides, a prospective multicenter randomized controlled trial by Getgood et al [28] showed similar outcomes.…”