Study Summary

10 studies including patients with anterior cruciate ligament (ACL) injuries undergoing primary ACL reconstruction were included in this systematic review and meta-analysis comparing ACLR with a lateral extra-articular procedure (LEAP) versus isolated ACLR. Pooled outcomes of interest included rotatory instability (pivot-shift), graft rupture, pain, self-reported function (IKDC, Lysholm, Tegner), quality of life, and physical performance. Overall, the pooled analyses demonstrated that adding a LEAP significantly reduced rotatory instability and graft rupture rates, while early postoperative outcomes such as pain and muscle weakness were worse in the combined procedure group but resolved within months. Functional patient-reported outcomes were generally similar between groups at later follow-up. These findings suggest that ACLR combined with a lateral extra-articular procedure improves knee stability and reduces graft failure risk, particularly in higher-risk patients, although it may result in transient early postoperative morbidity.