An isolated lateral extra‐articular procedure for persisting rotatory instability following ACL reconstruction has low failure rates with good clinical and patient‐reported outcomes: A systematic review and meta‐analysis

Abstract Purpose The purpose of this systematic review was to evaluate the clinical and patient‐reported outcomes of an isolated lateral extra‐articular procedure (LEAP) performed to address persistent rotatory instability following a previous isolated anterior cruciate ligament reconstruction (ACLR) in the absence of complete graft rupture. Methods A literature search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies reporting on an isolated LEAP performed to address instability after a standalone ACLR, without a complete graft tear, were included. Pre‐operative factors analysed included time from index ACLR, graft type, graft status and tunnel position, associated meniscal tears and grade of pivot shift. Pre‐ and post‐operative patient‐reported outcome measures (PROMs), and post‐operative clinical outcomes (including the grade of residual pivot shift) were also analysed. The rate of subsequent complete graft rupture or persisting instability was noted. Results Five studies with a total of 74 knees were included. These comprised 42 males and 32 females with an age range of 17–41 years and mean follow‐up of 25.5 ± 6.9 (12–30) months. There was a statistically significant improvement in pivot shift grade distribution from pre‐operative (27 Grade 1, 16 Grade 2 and 9 Grade 3) to post‐operative (8 Grade 1, 0 Grade 2 and 0 Grade 3) ( χ 2 test, p < 0.001). A random effects meta‐analysis showed a statistically significant improvement between pre‐ and post‐operative values for International Knee Documentation Committee (IKDC), Lysholm and Tegner Activity Scores. The pooled rate of complete graft rupture or persisting instability was 5.4% (0%–10.5%). Conclusion An isolated LEAP is an effective procedure with good clinical and patient‐reported outcomes and low failure rates for patients with persisting rotatory instability after a previous ACL reconstruction. Level of Evidence Level IV.