J Exp Orthop. 2026 Sep 17;13(3):e70908. doi: 10.1002/jeo2.70908. eCollection 2026 Jul.
ABSTRACT
PURPOSE: The aim of this systematic review was to evaluate clinical outcomes of combined primary anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP) in elite and competitive athletes. Where enough data were available, the review also aimed to differentiate between various LEAP techniques.
METHODS: A systematic search was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines using the PubMed, Scopus, Embase and Web of Science databases. Two independent observers screened and assessed the studies; the data were analysed cumulatively where possible and reported narratively.
RESULTS: A total of 12 studies met the inclusion criteria, reporting data on 1.719 knees that underwent primary ACLR. An additional LEAP was performed in 783 cases, including anterolateral ligament reconstruction (ALLR), the modified Lemaire and MacIntosh Coker-Arnold techniques. Notably lower graft failure rates were observed, ranging from 0% to 6.5% in the combined ACLR and LEAP groups, compared to 0%-34.0% in the isolated ACLR groups. The cumulative graft failure rate was 3.4% (10/292) for combined ACLR and ALLR, and 2.5% (4/158) for combined ACLR and modified Lemaire, compared to 10.7% (81/758) for isolated ACLR. Return to sport (RTS) rates were similar, ranging from 85.7% to 100% in the combined ACLR and LEAP group, and from 85.6% to 100% in the isolated ACLR group.
CONCLUSION: Based on this study, adding a LEAP to primary ACLR was associated with lower observed graft failure rates and improved knee stability, while return-to-sport rates remained similar in elite and competitive athletes.
LEVEL OF EVIDENCE: Level IV, systematic review.
PMID:42757382 | PMC:PMC13585434 | DOI:10.1002/jeo2.70908