The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis.

ABSTRACT

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.