The addition of a lateral extraarticular procedure to anterior cruciate ligament reconstruction improves clinical outcome.

Aim:<br/>To evaluate whether the addition of a Lateral Extra-Articular Procedure (LEAP) to<br/>Anterior Cruciate Ligament Reconstruction (ACLR) yields superior outcomes compared<br/>to isolated ACLR.<br/><br/>Design:<br/>Systematic literature review and meta-analysis<br/><br/>Methods:<br/>Five databases were systematically searched for randomized controlled trials (RCTs)<br/>comparing ACLR with the addition of a LEAP versus isolated primary ACLR. Studies<br/>were included in meta-analysis when comparable outcome measures at equivalent<br/>time points were reported in at least two studies.<br/><br/>Results:<br/>Fifteen RCTs were included in this review with ten eligible for meta-analysis. Metaanalysis demonstrated the addition of a LEAP significantly reduced rotatory instability<br/>(RR 1.45 [95%CI 1.17, 1.79]; p=0.0006) and graft rupture rates (RR 0.21 [95%CI 0.08,<br/>0.55]; p=0.001). Short-term postoperative morbidity, including heightened pain, joint<br/>stiffness, and reduced muscle strength in the LEAP group, resolved by 6-12 months<br/>post-surgery. No association between LEAPs and accelerated knee osteoarthritis was<br/>identified.<br/><br/>Conclusion:<br/>ACLR with the addition of LEAPs demonstrates superior clinical outcomes compared to<br/>isolated ACLR. Although early postoperative outcomes favoured isolated ACLR<br/>regarding pain and function, these effects resolved within 6-12 months. Current<br/>evidence remains insufficient to establish a relationship between LEAPs and<br/>accelerated knee osteoarthritis.