Clinical Outcomes of Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis Combined With Primary ACL Reconstruction: A Systematic Review With Meta-analysis.

Autor:	Na BR; Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea., Kwak WK; Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea., Seo HY; Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea.; Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea., Seon JK; Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea.; Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2021 Sep 13; Vol. 9 (9), pp. 23259671211023099. Date of Electronic Publication: 2021 Sep 13 (Print Publication: 2021).
DOI:	10.1177/23259671211023099
Abstrakt:	Background: Residual rotational instability after isolated anterior cruciate ligament reconstruction (ACLR) has been a challenge for many years. Anterolateral extra-articular procedures (AEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET), are performed as a surgical option for additional rotational stability, but clear evidence for their usefulness is lacking. Purpose: To conduct a systematic review and meta-analysis of the literature regarding the efficacy of AEAP in primary ACLR. Study Design: Systematic review; Level of evidence, 3. Methods: A literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. MEDLINE, EMBASE, and the Cochrane Library were searched in April 2020, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 3444 studies were screened, and 20 studies (11 randomized controlled trials and 9 nonrandomized studies) were evaluated. Functional outcomes, stability, and complications were compared between patients who underwent primary ACLR with AEAP and those who underwent isolated primary ACLR. For subgroup analysis, outcomes were compared according to AEAP technique (ALLR vs LET) and time from injury to surgery (≤12 vs >12 months). The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool, Jadad scale, and Newcastle-Ottawa Scale. Results: Compared with isolated ACLR, combined ACLR with AEAP led to improved pivot-shift grades and graft failure rates, regardless of the AEAP technique or of time from injury to surgery. A limited, marginal improvement in subjective function score was observed in patients who underwent AEAP combined with ACLR. In contrast to ALLR, patients who underwent LET combined with ACLR had an increased risk of knee stiffness and adverse events. Conclusion: Our review suggests that when there is a need to improve rotational stability and subjective function, AEAP combined with primary ACLR can be considered regardless of time from injury. ALLR appeared to be a better option for improving rotational stability compared with LET. Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. (© The Author(s) 2021.)
Databáze:	MEDLINE
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