Isolated ACL reconstruction vs combined with Lateral Extraarticular Procedures in patients 25 or younger: A Systematic-Review with meta-analysis.

Abstract

Introduction: ACL ruptures are extremely prevalent worldwide. Despite the commonness of this injury, isolated ACL Reconstruction (ACLR) results remain insufficient with young patients reporting high rates of graft failure. Recent studies reported some improvements when a Lateral Extraarticular Procedure (LEAP) was performed concomitantly with ACLR in a general population. This study aims to assess if the addition of a LEAP to ACLR leads to better clinical outcomes in patients 25 or younger. Materials and methods: This study was performed according to the PRISMA guidelines. The literature search, data extraction, and quality assessment of the studies were conducted by 2 independent reviewers using PubMed, Scopus and Web of Science. We included studies comparing isolated ACLR to ACLR with LEAPs in patients 25 or younger that reported on graft failure rate or patient-reported outcomes (PROs). Results: Six articles and 1280 patients were included. Our meta-analysis showed that the addition of a LEAP significantly reduced graft failure rate (RR = 0,31; 95% C.I. [0,19; 0,53]) and lead to higher rate of return to sports at the same level (RR = 1.2943; 95% C.I. [1,2051; 1.3901]). One of the studies also reported better pivot-shift test results when a LEAP was added. On the contrary, one study reported worse patient reported outcomes (PROs) in the first months after surgery with the addition of a LEAP. No statistically significant differences were found in PROs at final follow-up or any remaining outcomes. Conclusion: Adding a LEAP to ACLR in patients 25 or younger appears to lower graft failure rate and improve the rate of return to the same level of sports. PROs appear to be worse in the initial months when a LEAP is added but eventually evolve to be similar or possibly even better. More studies are needed to solidify the findings of this review.