Background and Objectives: The present systematic review investigated the efficacy of lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) as lateral extra-articular procedures (LEAPs) for anterior cruciate ligament (ACL) reconstruction. ACL reconstruction using LEAP may reduce graft rupture and rotatory laxity and allow a quicker return to sports. The outcomes of interest were patient-reported outcome measures (PROMs), return to sport, laxity, failure rate, and safety profile. Materials and Methods: The present systematic review followed the 2020 PRISMA guidelines. In December 2024, PubMed, EMBASE, and Web of Science were accessed without constraints. All clinical investigations evaluating LEAP for ACL reconstruction were considered. Only studies that considered LET and ALL as LEAP were considered. Only studies using a hamstring tendon autograft associated with LET or ALL were considered. Results: Data from 27 clinical studies (3423 patients) were retrieved. The mean length of follow-up was 61.8 ± 39.5 months. ACL reconstruction using LEAP led to a statistically significant improvement in the Lysholm score (p < 0.01) and IKDC (p < 0.01). The mean joint laxity, as measured by the arthrometer, was 1.5 ± 1.8 mm. Finally, 72.3% (623 of 668) of patients returned to their pre-injury level of sport at a mean of 6.3 ± 4.4 months. At the last follow-up, the LET group showed greater IKDC (p = 0.04). On the other hand, there was a statistically significant greater rate of patients positive to the Lachman test (p < 0.01), return to sport (p < 0.01), and reoperation (p = 0.01). No significant differences were found in Lysholm scores (p = 0.6), Tegner scores (p = 0.2), arthrometer measurements (p = 0.2), Pivot shift test results (p = 0.1), time to return to sport (p = 0.3), and failure rates (p = 0.7). Conclusions: LEAP for ACL reconstructions seems to be effective and safe. Most patients returned to their pre-injury level of sport after a mean of 6 months. LET-based ACL reconstruction may be associated with greater clinical outcomes and a higher reoperation rate compared to ALL-based reconstruction.

The aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

This study aims to compare the rate of meniscal tears after anterior cruciate ligament (ACL) reconstruction in patients who have undergone concomitant meniscal repair during the index procedure with that in patients who have not undergone such surgery. It also evaluates other risk factors, such as age, gender, race, body mass index (BMI), site of concomitant meniscal surgery, and ACL graft failure. This is a retrospective study conducted at a large tertiary public hospital. Patients who underwent primary anterior cruciate ligament reconstruction (ACLR) surgery with or without concomitant meniscal repair from 2011 to 2016 were identified. Patients with old meniscal tears and previous meniscal surgeries were excluded. The aforementioned demographical, injury, and surgical details were obtained and analyzed using univariate and multivariate logistic regression analysis. Our study cohort included 754 patients. Primary ACLR surgery was performed with meniscal repair in 172 (22.8%) of the patients, with meniscectomy in 202 (26.8%) of the patients, and without concomitant meniscal surgery in 380 (50.4%) of the patients. A total of 81 (10.7%) patients developed meniscal tears after the index procedure. Such tears occurred in 12.2% (21 of 172) of the patients who had undergone concomitant meniscal repair during the index ACLR, and in 10.3% (60 of 582) of the patients who had not undergone concomitant meniscal repair (p = 0.30). On multivariate analysis, only ACL graft failure was significantly associated with new meniscal tears (p < 0.001, odds ratio 18.69, 95% confidence interval 9.18–38.05). ACL graft failure is the only independent risk factor for meniscal tears after ACLR surgery in our large cohort of patients. Concomitant meniscal repair was not an associated risk factor.

Background: Anterior cruciate ligament (ACL) injuries are common in sports. These injuries often present with ≥1 meniscal tears, which may affect pre- and postoperative patient outcomes. Purpose: To compare patient-reported outcome measures (PROMs) between isolated ACL reconstruction (ACLR) and ACLR with concomitant meniscal surgery, such as meniscal repair or arthroscopic partial meniscectomy, over 2 years to aid in preoperative counselling and rehabilitation. Study Design: Cohort study; Level of evidence 3. Methods: This retrospective study included 415 consecutive patients who underwent ACLR at a tertiary referral hospital between January 2009 and December 2022. PROMs—including the Knee injury and Osteoarthritis Outcomes Score (KOOS) and the Lysholm score—were assessed preoperatively and at the 2-year follow-up between the isolated ACLR group and the ACLR with meniscal surgery group using the Mann-Whitney U test. A Wilcoxon signed-rank test within groups was used to assess preoperative to the 2-year follow-up improvements. Also, 95% CIs were utilized to provide the likely values of the true population mean. Two-tailed significance tests were used, and the statistical significance level was set at P < .05. Results: The patients in the 2 groups (isolated ACLR group, n = 205 and ACLR with meniscal surgery group, n = 210) had similar baseline characteristics for age, sex, and body mass index ( P > .05). The meniscal surgery group showed significantly worse Lysholm scores (71.1 [95% CI, 68.8-73.5] vs 74.9 [95% CI, 72.6-77.1]; P = .017) and KOOS domain scores preoperatively compared with the isolated ACLR group: KOOS Symptoms, 72.4 (95% CI, 69.9-75) versus 77.3 (95% CI, 75-80) ( P = .011); KOOS Activities of Daily Living, 81.4 (95% CI, 79-83.7) versus 85.6 (95% CI, 83.6-87.6) ( P = .006); KOOS Pain, 76.3 (95% CI, 73.9-78.8) versus 81(95% CI, 78.7-83.2) ( P = .006); and KOOS Quality of Life, 39.4 (95% CI, 36.4-42.5) versus 43.9 (95% CI, 41-46.9) ( P = .028). However, the KOOS Sport and Recreation domain had a lower and insignificant mean (35.6 [95% CI, 31.7-39.4] vs 39.9 [95% CI, 36.2-43.6]; P = .061). Both groups significantly improved across all PROMs at the 2-year follow-up ( P < .001). When compared with the isolated ACLR group, the meniscal surgery group had lower postoperative scores for Lysholm scores (93.8 [95% CI, 92.6-95] vs 95.3 [95% CI, 94.3-96.4]; P = .017), the KOOS Sport and Recreation Function (87.5 [95% CI, 85.1-90] vs 89.6 [95% CI, 87-92.2]; P = .025), and the KOOS Pain (97 [95% CI, 96-98] vs 96.7 [95% CI, 95.9-97.6]; P = .010), with insignificant differences in other KOOS domains ( P > .05). Conclusion: The study demonstrated that patients undergoing ACLR with concurrent meniscal surgery initially showed slightly poorer functional scores compared with those who underwent isolated ACLR. Both groups showed significant postoperative improvements. However, patients requiring surgical intervention for concurrent meniscal injuries can expect poorer functional outcomes than those requiring isolated ACLR, even after 2 years. These data may be important when counselling patients presenting with ACL tears who need to receive surgical treatment.