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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2026, Number 3

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Acta Ortop Mex 2026; 40 (3)

Meta-analysis of anterior cruciate ligament reconstruction, with and without anterolateral reinforcement: clinical and functional outcomes stratified by age and sport level

Morales-Valdes J, Sáenz-González M

Language: Spanish
References: 30
Page: 141-155
PDF size: 981.89 Kb.


ABSTRACT

Introduction: although anatomic anterior cruciate ligament reconstruction (ACLR) typically restores anteroposterior stability, residual rotational laxity—often manifesting as a positive pivot-shift test—may persist in some patients. To address this, anterolateral augmentation procedures, such as lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction, have regained interest for enhancing rotational control and graft protection. Material and methods: we conducted a systematic review and meta-analysis (PRISMA guidelines) of 31 Level I–II comparative studies (randomized trials and cohort studies) involving a total of 3,172 patients with a minimum follow-up of 12 months. Studies compared isolated ACLR versus ACLR with anterolateral reinforcement. Pooled outcomes included objective stability measures (pivot shift, Lachman test, instrumented laxity), patient-reported functional scores (IKDC, Lysholm, Tegner), and graft re-rupture rates. Results: the addition of anterolateral reinforcement significantly reduced the risk of residual pivot shift (RR = 0.45; 95%CI: 0.37-0.55; p < 0.001), indicating a 55% lower likelihood of postoperative rotational instability. Graft re-rupture rates were also lower in the augmented group (3.8 vs 11.3%; RR = 0.33; 95%CI: 0.24-0.48). Functional outcomes were slightly better with combined procedures: pooled IKDC scores were 2.96 points higher (95%CI: 0.47-5.45), Lysholm scores increased by 2.43 points (not statistically significant), and Tegner scores were 0.47 points higher (95%CI: 0.06-0.88). Conclusions: this meta-analysis indicates that supplementing ACL reconstruction with an anterolateral procedure provides superior rotational stability and lowers graft failure rates, without compromising short-term patient-reported outcomes. These findings support the consideration of combined approaches in patients at elevated risk of persistent rotational instability—particularly pivoting athletes.


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EVIDENCE LEVEL

II (metaanálisis de estudios clínicos)




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