Combining ACL Reconstruction with Lateral Extra-Articular Tenodesis Reduces Long-Term Osteoarthritis Risk Versus...

Lateral extra-articular tenodesis (LET) is increasingly used to augment anterior cruciate ligament reconstruction (ACLR), particularly in patients with high-grade rotatory instability. Despite demonstrated biomechanical advantages, the long-term effect of LET on posttraumatic osteoarthritis (OA) remains unclear.

We hypothesized that adding LET to ACLR reduces development of long-term moderate-to-severe radiographic OA, particularly after meniscectomy. We performed a PRISMA-compliant systematic review and meta-analysis, which was registered with PROSPERO. PubMed, Cochrane CENTRAL, and Scopus were searched through March 2025. Eligible randomized controlled trials (RCTs) or comparative cohort studies reported radiographic moderate-to-severe OA after ACLR with versus without LET, with a minimum follow-up of 5 years. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Six studies with 444 patients (mean follow-up, 13.1 years) were included. LET was associated with a significant reduction in moderate-to-severe OA in the lateral compartment. Subgroup analysis showed a significant reduction in lateral OA as measured using both the Kellgren-Lawrence (K-L) (OR, 2.87; 95% CI, 1.2 to 6.9; p = 0.02) and International Knee Documentation Committee (IKDC) classifications (OR, 4.38; 95% CI, 1.5 to 12.7; p = 0.01). In contrast, no significant difference was found in the medial compartment for either the K-L (OR, 1.26; 95% CI, 0.7 to 2.4; p = 0.49) or IKDC classification (OR, 2.06; 95% CI, 0.6 to 6.8; p = 0.24). In meniscectomized knees, LET significantly reduced OA risk, especially as measured with the IKDC (OR, 6.14; 95% CI, 1.7 to 22.6; p = 0.01) compared with the K-L classification (OR, 3.61; 95% CI, 1.1 to 12.3; p = 0.04). In contrast, although LET also reduced OA risk in non-meniscectomized knees, the difference was not significant. Compartment-specific OA data were unavailable within the meniscal subgroups.

This meta-analysis, the first to assess the long-term effect of LET on OA, indicated that LET significantly reduces moderate-to-severe OA risk, particularly in the lateral compartment and among meniscectomized knees. Findings support selective LET use during ACL reconstruction, especially in cases with compromised meniscal integrity, to help mitigate OA progression.

Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.