2025 AAOS Annual Meeting: Graft Choice for Anterior Cruciate Ligament Reconstruction with Concurrent Lateral ExtraArticular Procedure: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

One thousand nine hundred thirty-five patients undergoing ACLR were included across thirteen randomized controlled trials comparing isolated ACLR to ACLR with a concomitant lateral extra-articular procedure (LEP) using either hamstring tendon (HT) or bone-patellar tendon-bone (BPTB) grafts. The primary outcome was graft failure. Secondary outcomes included graft rupture, clinical failure, residual pivot shift, residual anterior-posterior laxity, and patient-reported outcomes such as IKDC, Lysholm, and Tegner scores, along with complication rates. Outcomes were assessed at final follow-up as reported in each study. Overall, the results revealed that ACLR with HT graft plus LEP significantly reduced rates of graft rupture (OR: 0.28), graft failure (OR: 0.28), and clinical failure (OR: 0.48) compared to isolated ACLR. BPTB grafts with LEP also reduced clinical failure (OR: 0.30). Both HT and BPTB grafts with LEP improved Lysholm scores. These findings suggest that incorporating LEP, particularly with HT grafts, may enhance surgical outcomes following ACLR.