Comparative study between lateral extra-articular tenodesis versus anterolateral ligament reconstruction in combination with anterior cruciate ligament reconstruction

BACKGROUND: Residual laxity after anterior cruciate ligament reconstruction (ACL-R) is found in some cases. Nowadays, anterolateral augmentation procedures are performed to prevent this laxity. MATERIALS AND METHODS: A prospective randomized comparative clinical study took place from January 2021 to November 2022. The study included 48 patients after exclusion of losses to follow-up, who acquired ACL-R combined with either lateral extraarticular tenodesis (LET) in 25 or anterolateral reconstruction (ALL) in 23 patients. The patients were evaluated with the Tegner-Lysholm score, and follow-up was for 26 ± 7 months. Also, laxity tests, pivot shift and Lachman preoperatively and postoperatively were evaluated. The failure rate was assessed. RESULTS: Tegner-Lysholm score improved significantly from 51.28 preoperatively to 93.76 points two years postoperatively in the LET-group and from 54.55 preoperatively to 94.23 points two years postoperatively in the ALL-group (P-value < 0.0001 in both groups). There was no significant difference between values of the Tegner-Lysholm score for the two groups at two-year follow-up (P-value = 0.24). Also, there was a significant reduction in the number of patients with positive pivot shift and Lachman tests in each group (P value < 0.0001 in both groups). The failure rate was 8% for LET and 8.7% for ALL (P-value = 0.46). Revisions were done from the contralateral side within the follow-up period. CONCLUSIONS: The clinical outcome and stability after anterior cruciate ligament reconstruction combined with either lateral extraarticular tenodesis or anterolateral ligament reconstruction improved significantly after two years. However, no significant difference between them was found after two years. Both groups had comparable failure rates. However, the intraoperative and postoperative findings support anterolateral ligament reconstruction. LEVEL OF EVIDENCE: Level 1, prospective randomized comparative study. TRIAL REGISTRATION: Clinical trial registry: NCT06222814. Registered at 01/01/2024, retrospectively. KEY POINTS: Comparative study between extraaricular tenodesis and anterolateral reconstruction combined with ACL-R., Clinical outcome after ACL reconstruction combination. Anterolateral Ligament Reconstruction or extraaricular tenodesis, rotatory and anterior laxity knee, lateral stabilization of the knee.