Title : Clinical and radiological outcomes of Anterior Cruciate Ligament Reconstruction (ACLR) with and without Lateral Extra-Articular Tenodesis (LET): A systematic review and meta-analysis
Abstract:
Introduction: Anterior Cruciate Ligament Reconstruction (ACLR) remains the gold standard for restoring knee stabilityafter ACL injury. Lateral Extra-Articular Tenodesis (LET) has been introduced to enhance rotational stability, but its impact clinically and joint preservation is debated. This meta-analysis aims to compare clinical and radiological outcomes of patients undergoing ACLR with LET versus isolated ACLR.
Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. Studies comparing ACLR+LET with iACLR were included if they reported validated clinical outcome scores (KOOS, Tegner, Lysholm, IKDC) or radiological classifications (Kellgren-Lawrence, Ahlback, Fairbank). Random-effects models were used to pool mean differences and odds ratios. Heterogeneity was assessed via I² statistics.
Results: ACLR+LET was associated with significantly improved clinical outcomes, including KOOS-QOL (MD= 67.34; 95% CI: 45.12 to 89.56), KOOS-ADL (MD = 92.66; 95% CI: 90.45 to 94.87), and KOOS-Recreation (MD = 64.49; 95% CI: 42.52 to 86.46). Lysholm scores showed no significant difference (MD = 1.37; 95% CI: –9.80 to 12.55), while data for Tegner and IKDC were insufficient for analysis. Radiological comparisons showed increased odds of changes in Kellgren-Lawrence (OR = 2.00; 95% CI: 0.23 to 17.10) and Ahlback (OR = 3.16; 95% CI: 0.36 to 27.43) classifications in the LET group, though these results lacked statistical significance due to wide confidence intervals and heterogeneity.
Conclusion: The addition of LET to ACLR improves several clinical outcomes and may influence radiological joint changes. Despite encouraging results, the radiographic findings remain inconclusive, and further high-quality studies are required to fully define the long-term.
