前外侧关节外肌腱固定术与ACL重建中前外侧韧带重建术的比较：一项系统评价
简介
该系统综述比较了前交叉韧带重建术中联合外侧关节外腱固定术（LET）与外侧韧带重建术（ALLR）的疗效。两种术式均较单纯重建显著改善旋转稳定性、降低轴移试验阳性率及移植物失败率，其中LET对旋转不稳的控制略优，而ALLR因解剖重建和软组织剥离少，患者重返运动更快。功能评分（Lysholm、IKDC等）两组相当，提示对高危患者行外侧结构增强可获益，但术式选择需权…
英文摘要
BACKGROUND: Residual anterolateral rotatory laxity and graft failure remain important challenges following anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular procedures (LEAPs), including Lateral Extra-articular Tenodesis (LET) and Anterolateral Ligament Reconstruction (ALLR), have gained renewed interest as adjuncts to ACLR; however, evidence comparing their effectiveness remains limited. The objective was to evaluate and compare the clinical and functional outcomes of LET and ALLR when performed in conjunction with ACLR. METHODS: A systematic review (PROSPERO: CRD420251082815) was conducted according to PRISMA 2020 guidelines. PubMed, EMBASE, and Scopus databases were searched for studies published within the last 10 years. Randomized controlled trials, cohort studies, and case-control studies comparing LET and/or ALLR combined with ACLR and reporting clinical or functional outcomes were included. Risk of bias was assessed using the ROBINS-I tool, and methodological quality was evaluated using the CASP checklist. Due to limited direct comparative evidence and heterogeneity among studies, a qualitative synthesis was performed. RESULTS: Seventeen studies met the inclusion criteria. Both LET and ALLR combined with ACLR demonstrated improved rotational stability, reduced pivot shift, and decreased instrumented anterior laxity compared with isolated ACLR. The addition of a LEAP was associated with lower graft failure rates. LET provided slightly superior control of rotatory instability, whereas ALLR was associated with faster return to sport, likely due to its anatomical reconstruction and less extensive soft-tissue dissection. Functional outcomes assessed using Lysholm, IKDC, KOOS, and Tegner scores were generally comparable. Hardware-related complications and reoperations were slightly more frequent with LET, although overall adverse event rates remained low. CONCLUSION: Augmentation of ACLR with either LET or ALLR improves knee stability and graft integrity, particularly in high-risk patients. ALLR may facilitate earlier return to sport, whereas LET may offer greater biomechanical restraint. Further high-quality randomized controlled trials with long-term follow-up are needed to establish definitive recommendations.