Background:Anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established surgical procedure, but it may not always restore complete rotational knee stability. Interest is increasing in anterolateral complex (ALC) procedures, lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), in association with ACLR to overcome this problem. The better ALC procedure, LET or ALLR, remains controversial to date.Purpose:To analyze the patient-reported outcome measures and ACL reinjury rate after ACLR with an ALC procedure compared with after isolated ACLR, as well as to analyze the clinical results and graft failure rate of the LET group versus the ALLR group.Study Design:Systematic review and meta-analysis; Level of evidence, 2.Methods:A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart was used to conduct a comprehensive search of 5 databases: Scopus, MEDLINE, Embase, PubMed, and the Cochrane Database of Systematic Reviews. Only randomized controlled trials were included. Eligible articles were classified according to the levels of evidence of the Oxford Centre for Evidence-Based Medicine. A methodological quality assessment of randomized controlled trials was performed using the Risk of Bias 2 tool. The present systematic review and meta-analysis was registered on PROSPERO.Results:A total of 14 clinical trials were included in the final analysis, with 1830 patients. Isolated ACLR or a combined procedure with LET or ALLR was performed, with several characteristics described, including the surgical technique, additional torn knee structures and their management, graft failure, complications, clinical outcomes, clinical and instrumental examinations to assess knee stability, and postoperative protocols. Regarding clinical outcomes, pivot-shift tests and reduced graft failure, a significant difference was found in the superiority of the combined ACLR associated with the ALC procedure compared with an isolated ACLR ( P < .05). No statistically significant difference was found between the 2 ALC procedures.Conclusion:This systematic review and meta-analysis reported on the importance of combined ACLR and ALC procedures in patients with a high-grade rotational laxity, as both procedures, LET or ALLR, without superiority of one over the other, are associated with improved pivot-shift tests, patient-reported outcome measures, and reduced graft failure rates.

中文翻译：

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将前外侧复杂手术与前十字韧带重建相结合可降低移植物再损伤率并改善临床结果：随机对照试验的系统回顾和荟萃分析

背景：前交叉韧带（ACL）重建（ACLR）是一种成熟的外科手术，但它可能并不总能恢复膝关节的完全旋转稳定性。人们对前外侧复合体 (ALC) 手术、外侧关节外肌腱固定术 (LET) 和前外侧韧带重建 (ALLR) 的兴趣日益浓厚，结合 ACLR 来克服这个问题。迄今为止，更好的 ALC 手术 LET 或 ALLR 仍存在争议。 目的：分析 ALC 手术后与单独 ACLR 手术相比患者报告的结果指标和 ACL 再损伤率，并分析临床结果和移植情况LET组与ALLR组的失败率。研究设计：系统回顾和荟萃分析；证据水平，2.方法：使用 PRISMA（系统评价和荟萃分析的首选报告项目）流程图对 5 个数据库进行全面检索：Scopus、MEDLINE、Embase、PubMed 和 Cochrane 系统评价数据库。仅纳入随机对照试验。符合条件的文章根据牛津循证医学中心的证据级别进行分类。使用偏倚风险 2 工具对随机对照试验进行了方法学质量评估。本次系统评价和荟萃分析已在PROSPERO上注册。结果：最终分析共纳入14项临床试验，共1830名患者。进行了单独的 ACLR 或 LET 或 ALLR 的联合手术，描述了几个特征，包括手术技术、额外撕裂的膝关节结构及其处理、移植物失败、并发症、临床结果、评估膝关节稳定性的临床和仪器检查以及术后协议。关于临床结果、枢轴移位测试和减少移植失败，与单独的 ACLR 相比，与 ALC 手术相关的联合 ACLR 的优越性存在显着差异 ( P < .05)。两种 ALC 手术之间没有发现统计学上的显着差异。结论：这项系统回顾和荟萃分析报告了联合 ACLR 和 ALC 手术对于高度旋转松弛患者的重要性，因为这两种手术（LET 或 ALLR）均无需进行一种相对于另一种的优越性与改进的枢轴移位测试、患者报告的结果测量和降低的移植失败率相关。