Purpose
To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior
cruciate ligament (ACL) reconstruction would provide greater control of rotational
laxity and improved clinical outcomes compared with ACL reconstruction alone.
Methods
Two independent reviewers searched 9 databases for randomized and nonrandomized clinical
studies comparing ACL reconstruction plus LET versus ACL reconstruction alone in a
human adult population. All years and 5 languages were included. Animal and cadaveric
studies, revision or repair surgical techniques, and studies focused on biomechanical
outcomes were excluded. Quality assessment of the included studies was performed with
the Cochrane Collaboration tool. Outcomes of interest included the pivot-shift test,
KT-1000/-2000 measurements (MEDmetric, San Diego, CA), and International Knee Documentation
Committee scores.
Results
The literature search yielded 3,612 articles. After titles and abstracts were reviewed,
106 articles were selected for full-text review, of which 29 studies met the inclusion
criteria (8 randomized and 21 nonrandomized studies). Of the 8 randomized studies,
3 concluded that the results were nonsignificant between treatment groups, 4 were
in favor of the extra-articular tenodesis, and 1 was in favor of the ACL reconstruction
alone. The Cochrane Collaboration tool showed an unclear to high risk of bias for
most articles. A meta-analysis showed a statistically significant difference for the
pivot-shift test (P = .002, I2 = 34%) in favor of ACL reconstruction with LET. No difference was found between the
groups for International Knee Documentation Committee scores (P = .75, I2 = 19%) and KT-1000/-2000 measurements (P = .84, I2 = 34%).
Conclusions
Meta-analysis showed a statistically significant reduction in pivot shift in favor
of the combined procedure. Studies lacked sufficient internal validity, sample size,
methodologic consistency, and standardization of protocols and outcomes.
Level of Evidence
Level III, systematic review of Level I, II, and III studies.
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Article info
Publication history
Published online: June 23, 2015
Accepted:
April 17,
2015
Received:
February 4,
2015
Footnotes
See commentary on page 2035
The authors report the following potential conflict of interest or source of funding: D.B. receives support from Empower, Canadian Institutes of Health Research, Smith & Nephew, and Arthrex. A.M.G. receives support from SBM, Musculoskeletal Transplant Foundation, Canadian Institutes of Health Research, Linvatec, and Smith & Nephew.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
