KSSTA - 2026-03-07 - Journal Article; Review
An isolated lateral extra-articular procedure for persisting rotatory instability following ACL reconstruction has low failure rates with good clinical and patient-reported outcomes: A systematic review and meta-analysis.
Sharma A, Tahir M, Davies P, de Sa D, Meena A, D'Alessandro P, Malik SS
Topics
Key Takeaway
Isolated lateral extra-articular procedures for persistent rotatory instability after intact-graft ACLR achieved a 5.4% pooled failure rate with significant improvement in pivot-shift grade and IKDC, Lysholm, and Tegner scores at mean 25.5 months.
Summary Depth
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Summary
This systematic review asked whether an isolated LEAP can address persistent rotatory instability after ACLR when the primary graft is intact. Five studies (74 knees) were pooled using random-effects meta-analysis. Pivot-shift grade distribution improved significantly (Grade 2/3 eliminated postoperatively; p<0.001), IKDC/Lysholm/Tegner all improved significantly, and pooled graft rupture or persistent instability rate was 5.4%.
Key Limitation
The entire evidence base consists of Level IV studies with only 74 knees, making it impossible to determine whether outcomes differ by specific LEAP technique, tunnel malposition severity, or degree of preoperative rotatory instability.
Original Abstract
PURPOSE
The purpose of this systematic review was to evaluate the clinical and patient-reported outcomes of an isolated lateral extra-articular procedure (LEAP) performed to address persistent rotatory instability following a previous isolated anterior cruciate ligament reconstruction (ACLR) in the absence of complete graft rupture.
METHODS
A literature search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on an isolated LEAP performed to address instability after a standalone ACLR, without a complete graft tear, were included. Pre-operative factors analysed included time from index ACLR, graft type, graft status and tunnel position, associated meniscal tears and grade of pivot shift. Pre- and post-operative patient-reported outcome measures (PROMs), and post-operative clinical outcomes (including the grade of residual pivot shift) were also analysed. The rate of subsequent complete graft rupture or persisting instability was noted.
RESULTS
Five studies with a total of 74 knees were included. These comprised 42 males and 32 females with an age range of 17-41 years and mean follow-up of 25.5 ± 6.9 (12-30) months. There was a statistically significant improvement in pivot shift grade distribution from pre-operative (27 Grade 1, 16 Grade 2 and 9 Grade 3) to post-operative (8 Grade 1, 0 Grade 2 and 0 Grade 3) (χ 2 test, p < 0.001). A random effects meta-analysis showed a statistically significant improvement between pre- and post-operative values for International Knee Documentation Committee (IKDC), Lysholm and Tegner Activity Scores. The pooled rate of complete graft rupture or persisting instability was 5.4% (0%-10.5%).
CONCLUSION
An isolated LEAP is an effective procedure with good clinical and patient-reported outcomes and low failure rates for patients with persisting rotatory instability after a previous ACL reconstruction.
LEVEL OF EVIDENCE
Level IV.