Graft Maturation in Postoperative MRI: A Systematic Review and Meta-analysis of Isolated vs. Anterolateral-Augmented ACL Reconstructions
A.C. De Albuquerque, N.F. Nascimento Filho, R.A.S. Conde, A.G.M. Da Silva, C.P. Helito, D.P. LealObjectives:
The purpose of this study is to evaluate whether the association of an anterolateral extra-articular procedure (tenodesis or anterolateral ligament reconstruction) to anterior cruciate ligament reconstruction (ACLR) reveals correlation regarding the graft maturation time.
Methods:
We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies comparing the graft maturation time between ACLR with anterolateral augmentation (ALA) to isolated ACLR. We assessed graft maturation, via Magnetic Resonance Imaging (MRI) using the signal-to-noise quotient (SNQ). Statistical analyses were performed using Review Manager 5.4. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were pooled using random-effects models based on heterogeneity (I²).
Results:
Five studies, including 450 patients, assessed graft maturation using SNQ values. No significant difference was observed between ACLR combined with Lateral extra-articular tenodesis (LET) or Anterolateral ligament reconstruction (ALLR) and isolated ACLR (MD -0.77; 95% CI -3.56–2.03; p=0.59; I²=92%), with substantial heterogeneity.
Conclusion:
The addition of ALA to ACLR does not appear to significantly enhance graft maturation. While some studies report improved stability, these benefits do not consistently translate into better ligamentization. The decision to augment ACLR should be individualized, considering population and individual characteristics.