Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of osteoarthritis: a systematic review and best evidence synthesis
The role of lateral extra-articular tenodesis (LEAT) as an augment to primary anterior cruciate ligament reconstruction (ACLR) remains controversial. However, concerns exist regarding the risk of development of osteoarthritis due to over constraint of the knee. To systematically review the literature to analyse the long-term incidence of osteoarthritis in patients who had an LEAT performed in isolation or in combination with intra-articular ACLR for the treatment of ACL deficiency.
Two reviewers independently searched five databases for randomized controlled trials (RCTs), non-randomized comparative, and retrospective cohort studies (CS) with long-term radiological follow-up of patients with ACL deficiency treated with ACLR combined with LEAT or LEAT in isolation. Risk of bias was performed using a modified Downs & Black’s checklist. The primary outcome was the development of osteoarthritis. The studies were divided into those with moderate/severe osteoarthritis at between 5 to 10 years and >10-year follow-up. The rate of meniscal pathology at the time of the index surgery was recorded. A best evidence synthesis was performed.
Eight studies reported on 421 patients in which an LEAT procedure was carried out. There were two high-quality RCTs and six low-quality CS. The follow-up was between 5- and 10-years in 5 studies and >10-years in 3. The presence of moderate/severe osteoarthritis was not detected in three studies and was found in 4/44 (9%) and 13/70 (18.6%) patients in the other two. At 11 year follow-up, one study demonstrated no osteoarthritis, while the other two studies reported rates of 54/100 (54%) and 17/24 (71%) respectively at >24 years. In the latter two cases, the rate of meniscal pathology was >50%. A best evidence synthesis revealed that there was insufficient evidence that the addition of a LEAT to an ACLR resulted in an increased rate of osteoarthritis.
The best available evidence would suggest that the addition of a LEAT to ACLR does not result in an increase rate of osteoarthritis of the knee. In knees that have undergone a combined ACLR and LEAT, the incidence of osteoarthritis was low up to 11 years but increased thereafter. The presence of meniscal injury at the index surgery was reported to be greater predictor of the development of osteoarthritis.
Level of evidence
KeywordsOsteoarthritis Anterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Anterior Cruciate Ligament Injury Lateral Compartment
Compliance with ethical standards
Conflict of interest
None of the authors declare that they have any conflict of interest related to this work.
This article is a systematic review and does not contain any studies with human participants or animals performed by any of the authors.
For this type of study formal consent is not required.
- 1.Acquitter Y, Hulet C, Locker B, Delbarre JC, Jambou S, Vielpeau C (2003) Patellar tendon-bone autograft reconstruction of the anterior cruciate ligament for advanced-stage chronic anterior laxity: Is an extra-articular plasty necessary? A prospective randomized study of 100 patients with five year follow-up. Rev Chir Orthop Reparatrice Appar Mot 89:413–422PubMedGoogle Scholar
- 8.Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW, Consortium M, the MG (2011) Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med 39:1889–1893.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD, Wright RW, Kaeding CC, Marx RG, Amendola A, McCarty EC, Spindler KP (2014) Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 42:1058–1067CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Dejour D, Vanconcelos W, Bonin N, Saggin PR (2013) Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction. Int Orthop 37:193–199CrossRefPubMedGoogle Scholar
- 26.Felson DT, Niu J, Gross KD, Englund M, Sharma L, Cooke TD, Guermazi A, Roemer FW, Segal N, Goggins JM, Lewis CE, Eaton C, Nevitt MC (2013) Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum 65:355–362CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Fox JM, Blazina ME, Del Pizzo W, Ivey FM, Broukhim B (1980) Extra-articular stabilization of the knee joint for anterior instability. Clin Orthop Relat Res 147:56–61Google Scholar
- 42.Simic M, Hinman RS, Wrigley TV, Bennell KL, Hunt MA (2011) Gait modification strategies for altering medial knee joint load: a systematic review. Arthritis Care Res (Hoboken) 63:405–426Google Scholar
- 45.Trichine F, Alsaati M, Chouteau J, Moyen B, Bouzitouna M, Maza R (2014) Patellar tendon autograft reconstruction of the anterior cruciate ligament with and without lateral plasty in advanced-stage chronic laxity. A clinical, prospective, randomized, single-blind study using passive dynamic X-rays. Knee 21:58–65CrossRefPubMedGoogle Scholar
- 47.Warren RF, Marshall JL (1978) A retrospective analysis of clinical records–part I. Clin Orthop Relat Res 136:191–197Google Scholar