Combined Anterior Cruciate Ligament Reconstruction (ACLR) and Lateral Extraarticular Tenodesis Using Modified Lemaire Technique versus ACLR alone : A Meta-Analysis of Clinical Outcomes

Abstract

Introduction: Anterior cruciate ligament (ACL) rupture was the most common injury that occurred in the knee. Reconstruction was the most common operative management used. After primary ACL reconstruction, a rerupture can be devastating. Several extraarticular procedures have been proposed to resolve rotatory instability, such as tenodesis. We determined to conduct a meta-analysis comparing ACL reconstruction (ACLR) with lateral extraarticular tenodesis (LET) using the modified Lemaire technique and evaluated the risk of failure or re-rupture rate and the outcome. Method: We conducted a meta-analysis based on The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search was conducted in June 2022 on several databases: PubMed, EBSCOHost, Scopus, ScienceDirect, and WileyOnline using Boolean operators focusing on PICO (Population, Intervention, Control, Outcome). Included studies will be extracted for characteristics such as author and study year, location, design, sample characteristics, failure (graft or clinical failure), and outcome (KOOS score, functional outcome, clinical outcome). Studies will be qualitatively and quantitatively evaluated using Review Manager 5.4 or equivalent. Result: Search was conducted and resulted in the five final studies with 797 patients. ACLR + LET has a lower risk of failure or re-rupture ratio than ACLR alone (RR= 0.44; 95% CI 0.26 – 0.75; I2=9%; p= 0.003). There were differences in the KOOS pain score, ADL score, sports score and QOL score with mean difference of 0.20 (95% CI 0.10, 0.30; I2=0%; p <0.0001), -0.20 (95% CI -0.26, -0.13; I2=0%; p <0.00001), 0.20 (95% CI 0.02, 0.38; I2=0%; p= 0.03), and 0.50 (95% CI 0.29, 0.71; I2=0%; p< 0.00001) respectively. Furthermore, there was a significant mean difference in the International Knee Documentation Committee score of 0.70 (95% CI 0.57, 0.83; I2=0%; p <0.000001). However, there were no significant differences in Lysholm score, and Tegner score between groups. Conclusion: LET was considered adequate in adjunction to ACLR, to minimize rerupture rate, and to improve stability and laxity of the knee to improve clinical outcome