Combined Anterolateral and Anterior Cruciate Ligament Reconstruction Improves Pivot Shift Compared to Isolated Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
PURPOSE
The purpose of the current study was to perform a systematic review and meta-analysis of the literature on anterolateral ligament (ALL) reconstruction as it related to techniques, biomechanical properties, and clinical outcomes.
METHODS
PubMed, OVID/Medline, and Embase were queried in July 2020. Data pertaining to (1)techniques, (2)biomechanical properties, and (3)clinical outcomes of ALL reconstruction were recorded. DerSimonian-Laird random-effects meta-analyses were performed for included randomized controlled trials comparing combined ALL/ACL reconstruction and isolated ACL reconstruction. Data from lower levels of evidence was described qualitatively and when possible, outcomes were reported as ranges to avoid inappropriate pooling of data.
RESULTS
A total of 46 articles were identified. Sixteen were biomechanical studies, 16 were clinical outcome studies, and 14 were technique studies. Of the 16 biomechanical studies, the majority demonstrated that anterior translation, internal rotation, and pivot shift was restored with combined ACL/ALL reconstruction and superior to ACL reconstruction alone. Ten biomechanical studies reported on constraint: four noted over-constraint when the femoral attachment site was proximal and posterior to the lateral femoral condyle, while one reported laxity. ACL failure rates after combined ACL/ALL reconstruction ranged between 2.7%-11.1%. The mean postoperative Lysholm score ranged between 58.7-98.0; mean postoperative IKDC between…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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