Anterior Cruciate Ligament (ACL) Reconstruction With Lateral Meniscal Repair With and Without Lateral Extra-articular Tenodesis: A Prospective Comparative Study of Functional and Rotational Outcomes
TL;DR
In this cohort of patients undergoing ACLR with lateral meniscal repair, the addition of LET was associated with improved postoperative rotational stability and functional outcomes, however, the non-randomized, indication-based allocation and baseline differences in rotational instability introduce potential confounding by indication.
Abstract
Background Residual anterolateral rotatory instability (ALRI) following anterior cruciate ligament (ACL) reconstruction (ACLR) may adversely affect functional outcomes and graft stability. Lateral extra-articular tenodesis (LET) has been proposed as an adjunct to ACLR to improve rotational stability. This study aimed to compare functional and rotational outcomes following ACLR with lateral meniscal repair with or without LET. Methods This prospective comparative study included 40 patients with ACL injury and concomitant lateral meniscal tear. Patients were allocated to Group A (ACLR + lateral meniscal repair + LET; n = 20) or Group B (ACLR + lateral meniscal repair; n = 20). Allocation was non-randomized and based on clinical risk factors, with patients demonstrating greater rotational instability preferentially allocated to LET. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) rating, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Rotational stability was assessed using the pivot-shift test at 12 months. Within- and between-group comparisons were performed using paired- and independent-sample statistical tests, as appropriate. Results Both groups demonstrated significant postoperative improvement in functional outcomes. At 12 months, mean IKDC scores were 84.8 ± 7.6 in Group A and 76.1 ± 8.6 in Group B, while mean KOOS scores were 88.8 ± 4.7 and 81.6 ± 6.4, respectively (both P < 0.05). Rotational stability was better in Group A, with 85% of patients demonstrating grade 0 pivot shift compared with 15% in Group B (P < 0.001). The LET group had greater baseline rotational instability, reflecting the indication-based treatment allocation. The mean 12-month Visual Analogue Scale (VAS) score was higher in Group A than Group B (1.9 vs 0.8). Conclusion In this cohort of patients undergoing ACLR with lateral meniscal repair, the addition of LET was associated with improved postoperative rotational stability and functional outcomes. However, the non-randomized, indication-based allocation and baseline differences in rotational instability introduce potential confounding by indication. Therefore, these findings should not be interpreted as definitive evidence of a causal treatment effect. Larger, adequately powered prospective studies with standardized graft selection and balanced baseline characteristics are required to confirm the independent effect of LET.