Purpose
To conduct a network meta-analysis (NMA) comparing the results of randomized controlled
trials (RCTs) among patients who underwent either isolated anterior cruciate ligament
(ACL) reconstruction or combined lateral extra-articular tenodesis (LET) or anterolateral
ligament reconstruction (ALLR).
Methods
RCTs that compared isolated ACL reconstruction and combined LET or ALLR were included
with minimum 12 months follow-up. Studies that used the double-bundle technique were
excluded. Outcome assessment included the number of positive pivot shifts, amount
of anterior tibial translation, and International Knee Documentation Committee (IKDC)
subjective, Tegner, and Lysholm scores. Bayesian NMA and the surface under the cumulative
ranking area (SUCRA) were evaluated.
Results
A total of 1,077 patients from 11 RCTs were enrolled in this study. In NMA, the odds
ratios (ORs) of positive pivot shift were significantly lower in ACL + ALLR (OR: 0.17;
95% CI: 0.027–0.67) than isolated ACL reconstruction, but no difference between ACL +
ALLR and ACL + LET. There were no significant differences in anterior tibial translation
among the techniques, but the IKDC subjective and Lysholm scores of ACL + ALLR and
ACL + LET were significantly higher than isolated ACL reconstruction. ACL + ALLR were
the most preferred in terms of residual pivot shift, anterior tibial translation,
and IKDC subjective scores (SUCRA = 88.2%, 86.4%, and 93.1%, respectively). Additional
lateral procedures resulted in significantly lower risk of graft failure (OR: 0.27;
95% CI: 0.1–0.71) than isolated ACL reconstruction.
Conclusions
ACL + ALLR were found to have significantly better outcomes in terms of knee rotational
stability and graft failure rate than isolated ACL reconstructions, but the clinical
outcomes were uncertain after a minimum 12 months follow-up. Considering the greatest
probability of obtaining better knee rotational stability in this NMA, ACL + ALLR
was found to be the most preferred technique for patients with ACL injury.
Level of Evidence
Level II, network meta-analysis and systematic review of Level I and II studies.
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Article info
Publication history
Published online: December 07, 2022
Accepted:
November 25,
2022
Received:
April 3,
2022
Footnotes
The authors report the following conflicts of interest or sources of funding: This study is supported by National Research Foundation of Korea, Republic of Korea (2021R1G1A1094372).
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
