Anterior Cruciate Ligament Reconstruction With or Without Lateral Extra-articular Tenodesis: A Systematic Review and Meta-analysis of Comparative Outcomes From Randomized Controlled Trials.

Authors

Faisal Alkhunein, Khalid Alrasheed, Rahaf Alrasheed, Mohammed Alorayyidh, Peter Cahusac, Hamzah Alhamzah

Published in

Orthopaedic journal of sports medicine. Volume 14. Issue 8. Pages 23259671261470939. Epub Aug 21, 2026.

Abstract

Clinical outcomes continue to be a concern after anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) has reemerged as an adjunct procedure for enhancing knee function; however, its overall clinical effectiveness remains controversial.
The addition of LET to primary ACLR would result in superior clinical, functional, and patient-reported outcomes as compared with isolated ACLR.
Systematic review and meta-analysis; Level of evidence, 1.
This study was conducted according to the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and registered in PROSPERO. Multiple databases were searched from 1995 to October 2025. Ten high-quality randomized controlled trials comparing ACLR with and without LET were included in the final meta-analysis. The outcomes assessed included graft failure, rotational and anterior knee stability, functional scores, patient-reported outcomes, and return-to-sport rates. Random effects models were used, and heterogeneity was evaluated.
When compared with isolated ACLR, ACLR augmented with LET demonstrated significantly lower graft failure rates (odds ratio [OR], -1.19; 95% CI, -1.73 to -0.65; P < .001) and improved rotational stability, as evidenced by superior pivot-shift outcomes (OR, -0.81; 95% CI, -1.11 to -0.52; P < .001). Significant improvements were also observed in Lysholm scores (OR, 1.98; 95% CI, 0.19-3.77; P = .030) and International Knee Documentation Committee (IKDC) subjective scores (OR, 1.65; 95% CI, 0.24-3.05; P = .22). No statistically significant differences were identified between the groups in KT-1000 measurements, Lachman test results, IKDC objective scores, Knee injury and Osteoarthritis Outcome Score subscales, Tegner activity scores, or return-to-sport rates. Heterogeneity was low across most outcomes (I ² = 0%), except for the Tegner scale (I ² = 83.12%).
The addition of LET to primary ACLR was associated with significantly improved graft survival (log OR, -1.19; 95% CI, -1.73 to -0.65; P < .001); enhanced rotational stability as demonstrated by improved pivot-shift outcomes (log OR, -0.81; 95% CI, -1.11 to -0.52; P < .001); and better patient-reported knee function, including Lysholm scores (mean difference, 1.98; 95% CI, 0.19-3.77; P = .030) and IKDC subjective scores (mean difference, 1.65; 95% CI, 0.24-3.05; P = .22). However, no significant benefits were observed in anterior laxity or return-to-sport rates.

PMID:
42633011
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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