There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction

Abstract

PurposeThe purpose of the current study is to systematically review and network meta-analyze the current evidence in the literature to ascertain if there is a superior lateral extra-articular augmentation technique in conjunction with anterior cruciate ligament (ACL) reconstruction (ACL.R) with respect to knee stability, re-rupture rates and functional outcomes. Methods The literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL.R to ACL.R + lateral extra-articular augmentation were included. Lateral extra-articular techniques included were anterolateral ligament reconstruction (ALL.R), Cocker-Arnold, Lemaire, Losee, Maraccaci, and McIntosh. Clinical outcomes were compared between ACL.R alone and the diferent lateral extra-articular augmentation techniques using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score. Results Twenty-eight studies with a total of 2990 patients were included. ACL.R + Cocker-Arnold technique had the highest P-Score for ACL re-ruptures and residual pivot-shift. ACL.R + Cocker-Arnold, Lemaire, and ALL.R all signiicantly reduced the rate of ACL re-rupture, and residual pivot-shift, compared to ACL.R alone. There was no signiicant diference between any of the lateral extra-articular augmentation techniques and ACL.R alone. ALL.R had the highest P-Score for return to play, and return to play at pre-injury level. Conclusion This study established that ACL.R + Cocker-Arnold, Lemaire and ALL.R resulted in signiicantly lower ipsilateral ACL re-ruptures, as well as reduced pivot-shift, compared to ACL.R alone. Whereas, the other lateral extra-articular augmentation techniques did not reduce pivot-shift and re-rupture. Additionally, functional outcomes and return to play were comparable between those who underwent ACL.R and lateral extra-articular augmentation and ACL.R alone. Level of evidence III.

Isolated lateral extra-articular tenodesis in ACL-deficient knees: in vivo knee kinematics and clinical outcomes

“…Several biomechanical and clinical studies have shown that LET can improve both the kinematics and the clinical results when associated with an ACL reconstruction [16, 17, 20, 37, 55]. Nevertheless, few of them have evaluated the capacity of LET itself to modify the mechanics of an ACL‐deficient knee.…”

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction in Pediatric Patients: Surgical Technique

“…Recent publications have shown the benefits of ALL reconstruction in achieving knee stability as well as reducing the iterative rupture rate. [13][14][15] Considering the high rerupture rate in the pediatric population, 6,7 reconstruction of both the ACL and ALL appears essential to us. To conclude, the described technique of combined ACL and ALL ligament reconstruction can be…”

Three-in-One Procedure for Revision ACL Reconstruction

“…The first main feature of the current ITB tenodesis is that we fix the anterior half of the ITB instead of the middle part of the ITB for modified Lemaire and other procedures PROCEDURE FOR ACL RECONSTRUCTION e5 because the route of the anterior part of the ITB is more like that of the native ACL. 10 The second main feature of current ITB tenodesis is that the ITB string is used to reconstruct the ACL, although the ITB strip is not so thick.…”