To compare the clinical outcomes of single-bundle reconstruction combined with anterolateral structure (ALS) reconstruction of anterior cruciate ligament (ACL) and single-bundle ACL reconstruction only.

A literature search was conducted in PubMed, Excerpta Medical Database (Embase), Web of Science, Wanfang database and China National Knowledge Infrastructure(CNKI). The references in the included literature were tracked, and clinical studies comparing single-bundle ACL reconstruction combined with ALS reconstruction and single-bundle ACL reconstruction were collected and compared, and the outcome indices were knee function scores, International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score, anterior tibial shift, etc.. The studies with a postoperative follow-up of less than one year, no controlled group or those that were not clinical studies, were excluded. The quality of the final included literatures was evaluated, the data were extracted and statistically analyzed using RevMan 5.3 software.

Ten studies were included, with a total of 764 patients, including 419 patients with single-bundle ACL reconstruction and 345 patients with single-bundle reconstruction combined with ALS reconstruction of ACL. The single-bundle reconstruction combined with ALS reconstruction of ACL were superior than single-bundle ACL reconstruction in the results of anterior tibial shift[mean deviation(MD)=-0.65, 95% confidence interval (CI) (-0.96, -0.33), P<0.01], IKDC score [MD=3.90, 95%CI(1.96, 5.84), P<0.01], Lysholm score [MD=2.65, 95%CI(1.73, 3.57), P<0.01], Tegner score [MD=0.31, 95%CI(-0.13, 0.75), P=0.17], pivot shift test[risk ratio(RR)=0.23, 95%CI(0.12, 0.44), P<0.01], Lachman test [RR=0.40, 95%CI(0.21, 0.77), P<0.01], and reducing the postoperative graft rerupture rate [RR=0.24, 95%CI(0.10, 0.54), P<0.01]; the differences were statistically significant. There was no statistically significant difference in anterior drawer test[RR=0.67, 95%CI(0.24, 1.89), P=0.44], or return-to-sport rate [RR=1.18, 95%CI(0.93, 1.48), P=0.17].

Single-bundle reconstruction combined with ALS reconstruction of ACL present advantages in terms of knee joint function score, stability and reduction of graft re-rupture rate.