前交叉韧带重建联合或不联合外侧关节外肌腱固定术：随机对照试验比较结果的系统评价与Meta分析
简介
该研究为一项纳入10项高质量随机对照试验的系统综述和荟萃分析，比较了前交叉韧带重建（ACLR）联合或不联合外侧关节外肌腱固定术（LET）的临床疗效。结果显示，ACLR联合LET可显著降低移植物失败率、改善轴移试验所反映的旋转稳定性，并提高Lysholm和IKDC主观评分，但前向松弛度和重返运动率无显著差异。上述证据支持对高旋转不稳风险患者考虑加用LET。
英文摘要
BACKGROUND: Clinical outcomes continue to be a concern after anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) has reemerged as an adjunct procedure for enhancing knee function; however, its overall clinical effectiveness remains controversial. HYPOTHESIS: The addition of LET to primary ACLR would result in superior clinical, functional, and patient-reported outcomes as compared with isolated ACLR. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 1. METHODS: This study was conducted according to the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and registered in PROSPERO. Multiple databases were searched from 1995 to October 2025. Ten high-quality randomized controlled trials comparing ACLR with and without LET were included in the final meta-analysis. The outcomes assessed included graft failure, rotational and anterior knee stability, functional scores, patient-reported outcomes, and return-to-sport rates. Random effects models were used, and heterogeneity was evaluated. RESULTS: When compared with isolated ACLR, ACLR augmented with LET demonstrated significantly lower graft failure rates (odds ratio [OR], -1.19; 95% CI, -1.73 to -0.65; P < .001) and improved rotational stability, as evidenced by superior pivot-shift outcomes (OR, -0.81; 95% CI, -1.11 to -0.52; P < .001). Significant improvements were also observed in Lysholm scores (OR, 1.98; 95% CI, 0.19-3.77; P = .030) and International Knee Documentation Committee (IKDC) subjective scores (OR, 1.65; 95% CI, 0.24-3.05; P = .22). No statistically significant differences were identified between the groups in KT-1000 measurements, Lachman test results, IKDC objective scores, Knee injury and Osteoarthritis Outcome Score subscales, Tegner activity scores, or return-to-sport rates. Heterogeneity was low across most outcomes (I 2 = 0%), except for the Tegner scale (I 2 = 83.12%). CONCLUSION: The addition of LET to primary ACLR was associated with significantly improved graft survival (log OR, -1.19; 95% CI, -1.73 to -0.65; P < .001); enhanced rotational stability as demonstrated by improved pivot-shift outcomes (log OR, -0.81; 95% CI, -1.11 to -0.52; P < .001); and better patient-reported knee function, including Lysholm scores (mean difference, 1.98; 95% CI, 0.19-3.77; P = .030) and IKDC subjective scores (mean difference, 1.65; 95% CI, 0.24-3.05; P = .22). However, no significant benefits were observed in anterior laxity or return-to-sport rates.