Does Adding LEAP to ACL Reconstruction Reduce Graft Failure? A Systematic Review and Meta-Analysis of Comparative...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Anterior cruciate ligament (ACL) reconstruction (ACLR) is standard for ACL rupture.
• Graft failure is a concern, particularly in young, active, or high-risk individuals.
• Lateral Extra-Articular Procedure (LEAP) addition aims to improve stability and reduce re-rupture.

Purpose of the Study:

• To systematically review and meta-analyze if adding LEAP to primary ACLR decreases graft failure rates versus isolated ACLR.
• To assess rotational stability, patient-reported outcomes, and complication rates with and without LEAP.

Main Methods:

• Systematic literature search of PubMed, Scopus, Embase, and Cochrane Library databases.
• Included 18 comparative studies (7336 patients) with a minimum 24-month follow-up.
• Analyzed graft failure rates using Mantel-Haenszel method with a fixed-effects model.

Main Results:

• ACLR + LEAP significantly reduced graft rupture risk compared to ACLR alone (RR 2.72; 95% CI: 2.23-3.32; p < 0.00001).
• LEAP showed particular benefit in high-risk populations (young athletes, high-grade pivot shift, ligamentous laxity).
• Improved rotational stability was observed with LEAP; patient outcomes and complications were comparable.

Conclusions:

• Isolated ACLR has a higher graft failure risk than ACLR with LEAP.
• LEAP enhances rotational stability post-ACLR without increasing complications.
• Consider LEAP selectively for high-risk patients or those with intraoperative instability.