The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis

Regarding “The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis”

“…To the best of our knowledge, all comparative clinical studies that have used a proximo-posterior femoral tunnel position and also clearly reported fixing ALL grafts in extension, have reported either a trend, or significant reduction in graft rupture rates with combined ACLþALL reconstruction, versus isolated ACL reconstructions. [13][14][15]19 This consistent finding across studies contrasts with the conclusions of Xu et al 1 It is apparent that even though meta-analyses are increasingly frequently published in the orthopaedic literature, there are important lessons to learn regarding their interpretation from the nonorthopaedic literature in which they have often been found to have conflicting findings (when more than one group of authors tackle the same subject) and rarely predict the outcome of subsequent large randomized controlled trials (RCTs). 20,21 We therefore share concerns regarding the increasing frequency of publication of meta-analyses in the sports medicine literature.…”

“…In closing, we would again like to thank Xu et al 1 for their important contribution to the literature. We recognize that conducting a meta-analysis is a significant undertaking and congratulate them on tackling this evolving topic.…”

“…We would like to congratulate Xu et al 1 on their recent publication titled "The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis." We read this article with great interest because meta-analyses carry considerable weight, they typically represent high-level evidence, and are frequently cited in the literature.…”

“…The first point to note is that Xu et al 1 included "all techniques of ALLR with different femoral and tibial fixation sites." It is important to recognize that this diverse range of surgical techniques exists because there has been considerable debate in the literature regarding the precise anatomy (in particular, the femoral insertion) and biomechanics of the anterolateral structures.…”

“…A final major limitation of Xu et al 1 is exclusion of a number of key Level III studies that have compared the outcomes of combined ACLþALL reconstruction against those of isolated ACL reconstruction. [13][14][15] It is clear that undertaking a meta-analysis is a complex task that should be undertaken in conjunction with a statistician, and in the case of such a controversial topic, perhaps also an expert consensus group to determine study eligibility.…”