Lateral Extra-articular Procedures With Anterior Cruciate Ligament Reconstruction: International Consensus

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Anterior cruciate ligament (ACL) graft failure is a significant concern in certain patient populations.
• Lateral extra-articular procedures aim to enhance ACL reconstruction outcomes by addressing graft failure and restoring knee kinematics.

Purpose of the Study:

• To establish international consensus on surgical indications for lateral extra-articular procedures in ACL reconstruction.
• To provide evidence-based recommendations for optimizing patient selection and improving graft survival rates.

Main Methods:

• A modified Delphi consensus process involving 53 international experts.
• Debate and voting on 20 specific surgical indications for lateral extra-articular procedures.

Main Results:

• Strong recommendations for lateral extra-articular procedures in ACL reconstruction with hamstring autografts for young/active, skeletally immature patients, and those with grade III pivot-shift or hyperextension.
• Recommendations for revision ACL reconstruction and chronic ACL deficiency.
• Considerations for other patient groups including those with specific graft types, return-to-sport athletes, and radiographic findings.

Conclusions:

• Lateral extra-articular procedures are strongly indicated in specific high-risk ACL reconstruction scenarios.
• These procedures offer a valuable adjunct to standard ACL reconstruction for improving knee stability and reducing graft failure.
• Expert consensus provides guidance for the judicious application of lateral extra-articular procedures in diverse clinical settings.