Functional Outcome of Lateral Extraarticular Tenodesis (LET) Procedure in Addition to Anterior Cruciate Ligament Reconstruction: A Metaanalysis

Aryana, I Gusti Ngurah Wien; Subawa, I Wayan; Dusak, I Wayan Suryanto; Dharmayuda, Cokorda Gde Oka; Nugraha, Hans Kristian; Deslivia, Maria Florencia

doi:10.1055/s-0041-1736514

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Sumário

Systematic Review and Meta-Analysis • Rev. bras. ortop. 57 (01) • 2022 • https://doi.org/10.1055/s-0041-1736514 copy

Functional Outcome of Lateral Extraarticular Tenodesis (LET) Procedure in Addition to Anterior Cruciate Ligament Reconstruction: A Metaanalysis^* * Work developed at Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Bali, Indonésia.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

The aim of the present study is to systematically review and analyze the functional outcome of lateral extraarticular tenodesis (LET) procedure in addition to anterior cruciate ligament reconstruction (ACLR) in studies with a high level of evidence.

Methods

We performed a literature search for clinical studies comparing the LET method as an augmentation to ACL reconstruction with ACL reconstruction alone. The primary outcomes were the International Knee Documentation Committee (IKDC) score, the Lysholm score, and graft failures. Continuous variables were reported as means and 95% confidence intervals (CIs).

Results

Six clinical studies with 1,049 patients were included in the metaanalysis. The follow-up period was, in average, 24 months (range, 6-63 months). The addition of the LET procedure to ACLR results in better functional outcome based on the IKDC score (p < 0.05). Graft failure was found to be lower in the ACLR plus LET group (16 of 342 patients) compared with the ACLR-only group (46 of 341 patients) (p < 0.05).

Conclusion

There is high-level evidence that LET procedure in addition to ACLR is preferable in terms of functional outcome and graft failure.

Keywords
anterior cruciate ligament reconstruction; anterior cruciate ligament injuries; joint instability; tenodesis

	Inclusion criteria	Exclusion criteria
Population	Patients aged ≥ 18 years or older with primary ACL rupture and planned to undergo ACL reconstruction with arthroscopy.	• Animal studies. • Revision cases of ACL reconstruction. • Concomitant PCL or meniscus reconstruction. • Underlying congenital condition or neoplasm.
Intervention	ACL reconstruction with lateral extraarticular tenodesis.	• ACLR with (ALL) reconstruction. • Pharmacologic treatment. • Nutrition treatment. • Physical therapy or rehabilitation which stands alone.
Control	ACL reconstruction alone.
Outcome	Primary outcome measures Clinical outcomes including the IKDC score, VAS for pain, and SF-36 for quality of life are the primary outcomes. Mean difference will be reported with 95% confidence intervals. Secondary outcome measures Additional outcomes of interest include complications. Dichotomous outcomes will be measured using risk ratios with 95% confidence intervals.	• Study is ongoing, and no results have been reported • Outcome measures not reported in completion

No	Author (year)	Adequate randomization^b	Concealed allocation	Patient blinded	Care provider blinded	Assessor blinded	Drop-out rate acceptable	Analyzed according to group	Free of selective outcome reporting	Similar at baseline	Cointerventions avoided	Compliance acceptable	Timing of outcome similar	No other sources of potential bias	Quality assessment
1	Dejour et al. (2013)	No	Unsure	No	No	No	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Moderate
2	Trichine et al. (2014)	Yes	Unsure	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	High
3	Ferretti et al. (2016)	Yes	Unsure	No	No	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	High
4	Getgood et al. (2019)	Yes	Yes	No	No	No	No	Yes	Yes	Unsure	Yes	Yes	Yes	Yes	High
5	Castoldi et al. (2020)	Yes	Unsure	No	No	No	No	Yes	Yes	Unsure	Unsure	Yes	Yes	Yes	High
6	Getgood et al. (2020)	Yes	Unsure	No	No	No	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	High

Study (year)	ALL augmentation technique	ALL augmentation graft	ACLR technique	ACLR graft	Age		Gender		Sample size		Mean follow-up
Study (year)	ALL augmentation technique	ALL augmentation graft	ACLR technique	ACLR graft	ACLR alone	ACLR + LET	ACLR alone	ACLR + LET	ACLR alone	ACLR + LET	ACLR alone	ACLR + LET
Dejour et al. (2013)	Modified Lemaire	Gracilis	Single Bundle	Bone patellar tendon bone graft	27.5 years (range: 14-42 years)	21.4 years (range: 14-34 years)	Male: 17 (68%)	Male: 20 (80%)	25	25	25.4 (range 18-30 months)	25.6 (range 14-33 months)
Trichine et al. (2014)	Kenneth Jones plasty	Iliotibial band	Single-incision arthroscopic technique (Kenneth Jones)	Patellar tendon	27.7 ± 4.75 years	28.6 ± 4.69 years	Comparable statistically		60	60	24.5 months (range 6-63 months)	23.4 months (range 6-45 months)
Ferretti et al. (2016)	MacIntosh modified by Cocker-Arnold	Iliotibial band	Single Bundle	Semitendinosus and gracilis	27.3 (range: 18-50 years)	25.7 (range: 18-46 years)	Male 51 (71%)	Male 56 (82%)	72	68	10 years 5 months (range 121-128 months)
Getgood et al. (2019)	Modified Lemaire	Iliotibial band	Triple bundle	Semitendinosus and gracilis	18.7 ± 3.2 years	19.0 ± 3.1 years	Male 79 (45.9%)	Male 75 (44.4%)	180	176	24 months	24 months
Castoldi et al. (2020)	Lemaire extra-articular tenodesis	Gracilis	NA	Bone patellar tendon bone graft	26 years (range: 15-40 years)		Male 43 (70%)	Male 47 (78%)	61	60	19.4 years (range, 19-20.2 years)
Getgood et al. (2020)	Modified Lemaire	Iliotibial band	Various	Semitendinosus and/or gracilis.	18.9 years (range: 14-25 years)		Male 151 (48%)	Male 151 (49%)	312	306	24 months	24 months

Study (year)	IKDC		Lysholm		Graft failure (%)
Study (year)	ACLR alone	ACLR + LET	ACLR alone	ACLR + LET	ACLR alone	ACLR + LET
Dejour et al. (2013)	90.1	86	NA	NA	NA	NA
Trichineet al. (2014)	92.1	88.2	NA	NA	NA	NA
Ferretti et al. (2016)	93.77 (SD 6.63)	96.19 (SD 3.3)	95.46 (SD 5.68)	96.24 (SD 3.5)	NA	NA
Getgood et al. (2019)	NA	NA	NA	NA	11.67%	13.07%
Castoldi et al. (2020)	81.1 (range, 42.5-100)	82.4 (range, 55.2-100)	86.6 (42-100)	90.3 (67-100)	47.54%	21.67%

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[1] Address for correspondence I Gusti Ngurah Wien Aryana, MD, RSUP Sanglah, Orthopaedi dan Traumatologi, Jl. Diponegoro, Dauh Puri Klod, Kec. Denpasar Bar., Kota Denpasar, Bali, Denpasar, Bali 80113, Indonesia (e-mail: wienaryana@unud.ac.id).

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Functional Outcome of Lateral Extraarticular Tenodesis (LET) Procedure in Addition to Anterior Cruciate Ligament Reconstruction: A Metaanalysis* * Work developed at Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Bali, Indonésia.

Abstract

Objectives

Methods

Results

Conclusion

Functional Outcome of Lateral Extraarticular Tenodesis (LET) Procedure in Addition to Anterior Cruciate Ligament Reconstruction: A Metaanalysis^* * Work developed at Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Bali, Indonésia.