Purpose
To determine whether combined anterior cruciate ligament reconstruction (ACLR) and
anterolateral ligament reconstruction (ALLR) result in better knee rotatory stability
and postoperative clinical outcomes than ACLR alone.
Methods
A computer literature search was conducted of Medline (1982 to April 2020), Embase
(1982 to April 2020), OVID (1982 to April 2020), and the Cochrane Library (1982 to
April 2020) to screen all therapeutic trials on combined ACLR and ALLR versus isolated
ACLR. Only level of evidence I and II clinical studies were included. The outcome
measures included (1) objective knee stability examination such as anterior drawer
test, Lachman test, KT-arthrometer measurement, and pivot shift test; (2) patient-reported
outcomes such as International Knee Documentation Committee (IKDC), Tegner activity
score, and Lysholm score; (3) return to play; and (4) graft rupture rate. Data were
extracted, pooled, and analyzed to compare the 2 groups.
Results
A total of 890 studies were screened, and 884 were excluded. Six clinical trials with
828 subjects were included in the final meta-analysis. In comparison to patients received
combined ACLR and ALLR, patients who received isolated ACLR had a significantly lower
negative pivot shift test rate (odds ratio [OR] 0.46, 95% confidence interval [CI]
0.23 to 0.92, I2 = 0%, P = .03, 95% prediction interval [PrI] 1.00 to 2.26), Lysholm score (mean difference
–2.79, 95 % CI –4.68 to –0.91, I2 = 77 %, P = .004, 95% PrI –10.81 to 5.42), Tegner score (mean difference –0.57, 95% CI –1.12
to –0.02, I2 = 90 %, P = .04, 95% PrI –3.12 to 1.93).
Conclusions
Combined ALLR and ACLR could effectively augment knee rotatory stability by reducing
pivot shift rate and moderately improve patients’ clinical outcomes. However, the
effect of ALLR on overall graft rupture rate cannot be confirmed.
Level of evidence
II, meta-analysis of level I and II studies.
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Article info
Publication history
Published online: October 21, 2020
Accepted:
October 10,
2020
Received:
May 18,
2020
Footnotes
C. Xu and J. Chen contributed equally to this work.
The authors report the following potential conflicts of interest or sources of funding: C.X. reports grants and nonfinancial support, National Key Research and Development Program of China, grants 2018YFC110620 and 2018YFC1106202, the Western Medicine Guidance Project of Science and Technology Commission of Shanghai Municipality, grant 17411966400, National Natural Science Foundation of China, grant 31400800. J.C. reports grants and nonfinancial support, National Key Research and Development Program of China, the Western Medicine Guidance Project of Science and Technology Commission of Shanghai Municipality, National Natural Science Foundation of China. E.C. reports grants and nonfinancial support, National Key Research and Development Program of China, the Western Medicine Guidance Project of Science and Technology Commission of Shanghai Municipality, National Natural Science Foundation of China. J.Z. reports grants and nonfinancial support, National Key Research and Development Program of China, the Western Medicine Guidance Project of Science and Technology Commission of Shanghai Municipality, National Natural Science Foundation of China. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
