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

Area of Science:

• Orthopedic surgery
• Sports medicine
• Biomechanical research

Background:

• Lateral extra-articular tenodesis (LET) is an emerging augmentation for anterior cruciate ligament reconstruction (ACLR), particularly for high-grade rotatory instability.
• The long-term impact of LET on posttraumatic osteoarthritis (OA) following ACLR remains incompletely understood.

Purpose of the Study:

• To investigate the long-term effect of adding LET to ACLR on the development of moderate-to-severe radiographic osteoarthritis.
• To specifically assess the influence of LET on OA risk in patients who have also undergone meniscectomy.

Main Methods:

• A PRISMA-compliant systematic review and meta-analysis of eligible randomized controlled trials and comparative cohort studies.
• Searched PubMed, Cochrane CENTRAL, and Scopus databases through March 2025.
• Included studies with a minimum 5-year follow-up, reporting radiographic OA after ACLR with versus without LET.

Main Results:

• Six studies (444 patients, mean follow-up 13.1 years) were analyzed.
• LET significantly reduced moderate-to-severe OA in the lateral compartment (K-L OR 2.87, IKDC OR 4.38).
• LET significantly reduced OA risk in meniscectomized knees (IKDC OR 6.14, K-L OR 3.61), but not significantly in non-meniscectomized knees.

Conclusions:

• LET significantly reduces the risk of moderate-to-severe osteoarthritis, particularly in the lateral compartment.
• The benefit of LET in reducing OA risk is more pronounced in knees that have undergone meniscectomy.
• Findings support the selective use of LET during ACLR in patients with compromised meniscal integrity to potentially slow OA progression.