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Title: 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.
Authors: Devitt, Brian
Bouguennec, Nicolas
Barfod, Kristoffer
Porter, Tabitha
Feller, Julian
Other Authors: Webster, Kate
Keywords: Anterior Cruciate Ligament Reconstruction
Tibial Meniscus Injuries
Lateral Extra-Articular Tenodesis
Long-Term Incidence
ACL Deficiency
Anterior Cruciate Ligament Deficiency
Randomized Controlled Trials
Non-Randomized Comparative
Retrospective Cohort Studies
Downs & Black's Checklist
Treatment Outcomes
Meniscal Pathology
Best Evidence Synthesis
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Apr-2017
Publisher: Springer
Citation: Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1149-1160
Abstract: PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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: IV.
DOI: 10.1007/s00167-017-4510-1
PubMed URL:
ISSN: 0942-2056
Journal Title: Knee Surgery, Sports Traumatology, Arthroscopy
Type: Journal Article
Affiliated Organisations: School of Allied Health, La Trobe University, Melbourne, Australia
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:Musculoskeletal

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