Lateral extra-articular procedures combined with ACL reconstructions lead to a higher return to pre-injury level of sport: A systematic review and meta-analysis

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-03-11 DOI:10.1002/jeo2.70196

Guus Felix Kerkvliet, Gijs Bram Peter Cornelis van der Ree, Inger Nicoline Sierevelt, Gino M. M. J. Kerkhoffs, Bart Muller

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Abstract

Purpose

To compare postoperative activity levels between patients who received an anterior cruciate ligament reconstruction (ACLR) with- and without a lateral extra-articular procedure (LEAP).

Objectives

The primary objective is to examine whether patients treated with an ALCR and LEAP have a greater chance to return to sport (RTS) and return to their pre-injury level of sport (RTPS). The re-rupture rates between the two groups will also be analysed as this is of great influence on the RTS and RTPS.

Methods

A thorough search according to PRISMA guidelines was conducted through the PubMed and Embase databases in May 2024. Randomised controlled trials (RCT) and retrospective cohort studies on patients who underwent primary ACLR with- or without a LEAP were included. Postoperative Tegner score, RTS, RTPS and re-rupture rate were evaluated. All articles were revised according to Cochrane risk of bias tools (RoB 2.0 and ROBINS-I).

Results

Twenty-four studies were included after examining 966 titles, abstracts and manuscripts. A total of 33,527 patients were included in this review with a weighted mean age of 24.9 years. Pooled data demonstrates that the ACLR + LEAP group shows significantly higher postoperative Tegner scores (MD, 0.43 [95% confidence interval, 0.21–0.65]; p < 0.01). 62% of patients who underwent ACLR + LEA returned to their pre-injury level of sport compared to 40% in ACLR group (reported in nine studies).

Conclusion

This meta-analysis demonstrates that patients undergoing a LEAP procedure in addition to ACLR return to higher postoperative activity levels and are more likely to return to their pre-injury level of sport. These results -in addition to further research- may help dictate when to add a LEAP, and whether LEAP in addition to ACLR should become the golden standard.

Level of Evidence

Level III, retrospective cohort studies have been analysed, alongside RCT's, and thus this is the level of evidence.

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外侧关节外手术联合前交叉韧带重建可使运动恢复到损伤前水平：一项系统回顾和荟萃分析

目的比较接受前交叉韧带重建（ACLR）和不接受外侧关节外手术（LEAP）的患者的术后活动水平。主要目的是研究接受ALCR和LEAP治疗的患者是否有更大的机会恢复运动（RTS）和恢复损伤前的运动水平（RTPS）。两组之间的再破裂率也将被分析，因为这对RTS和RTPS有很大的影响。方法根据PRISMA指南于2024年5月在PubMed和Embase数据库进行全面检索。随机对照试验（RCT）和回顾性队列研究纳入了伴有或不伴有LEAP的原发性ACLR患者。评估术后Tegner评分、RTS、RTPS及再破裂率。所有文章均根据Cochrane偏倚风险工具（rob2.0和ROBINS-I）进行修订。结果966篇论文题目、摘要和手稿共纳入24篇研究。本综述共纳入33,527例患者，加权平均年龄为24.9岁。合并数据显示，ACLR + LEAP组术后Tegner评分明显较高(MD， 0.43[95%可信区间，0.21-0.65]；p < 0.01)。62%的ACLR + LEA患者恢复到损伤前的运动水平，而ACLR组为40%（9项研究报道）。结论：本荟萃分析表明，接受LEAP手术和ACLR手术的患者术后活动水平更高，更有可能恢复到损伤前的运动水平。这些结果——加上进一步的研究——可能有助于决定何时添加LEAP，以及除了ACLR之外LEAP是否应该成为黄金标准。证据水平III级，回顾性队列研究与随机对照试验一起进行了分析，因此这是证据水平。

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