前交叉韧带重建术伴或不伴前外侧加强的Meta分析：按年龄和运动水平分层的临床与功能结局
简介
该meta分析纳入31项研究3172例患者，对比单纯ACL重建与联合前外侧加强（LET或ALL重建）的临床疗效。结果显示，联合手术可将术后轴移试验阳性风险降低55%（RR=0.45），移植物再断裂率由11.3%降至3.8%，IKDC评分亦提高约3分。对于旋转稳定性要求较高的变向运动人群，ACL重建联合前外侧加强具有明确临床价值。
英文摘要
INTRODUCTION: although anatomic anterior cruciate ligament reconstruction (ACLR) typically restores anteroposterior stability, residual rotational laxityoften manifesting as a positive pivot-shift testmay persist in some patients. To address this, anterolateral augmentation procedures, such as lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction, have regained interest for enhancing rotational control and graft protection. MATERIAL AND METHODS: we conducted a systematic review and meta-analysis (PRISMA guidelines) of 31 Level III comparative studies (randomized trials and cohort studies) involving a total of 3,172 patients with a minimum follow-up of 12 months. Studies compared isolated ACLR versus ACLR with anterolateral reinforcement. Pooled outcomes included objective stability measures (pivot shift, Lachman test, instrumented laxity), patient-reported functional scores (IKDC, Lysholm, Tegner), and graft re-rupture rates. RESULTS: the addition of anterolateral reinforcement significantly reduced the risk of residual pivot shift (RR = 0.45; 95%CI: 0.37-0.55; p < 0.001), indicating a 55% lower likelihood of postoperative rotational instability. Graft re-rupture rates were also lower in the augmented group (3.8 vs 11.3%; RR = 0.33; 95%CI: 0.24-0.48). Functional outcomes were slightly better with combined procedures: pooled IKDC scores were 2.96 points higher (95%CI: 0.47-5.45), Lysholm scores increased by 2.43 points (not statistically significant), and Tegner scores were 0.47 points higher (95%CI: 0.06-0.88). CONCLUSIONS: this meta-analysis indicates that supplementing ACL reconstruction with an anterolateral procedure provides superior rotational stability and lowers graft failure rates, without compromising short-term patient-reported outcomes. These findings support the consideration of combined approaches in patients at elevated risk of persistent rotational instabilityparticularly pivoting athletes.