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PurposeRecent evidence has found the antero‐lateral ligament (ALL) may play a role in stabilizing the knee, but its role in anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of the current study is to systematically review and meta‐analyze the current evidence in the literature to ascertain whether ACL reconstruction combined with ALL reconstruction affects knee stability, re‐rupture rates and patient‐reported outcomes compared to ACL reconstructions performed alone. MethodsA literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL + ALL reconstruction and ACL reconstruction alone were included. ResultsSix clinical trials (LOE I: I, LOE II: 2, LOE III: 3) with 729 patients were included, with a mean follow‐up time of 34.2 (24–54.9) months. There was a significant difference in favor of combined ACL + ALL reconstruction for reduced re‐rupture rate (2.4% vs 7.3%, p < 0.01), residual positive pivot shift rate (33.3% vs 11.4%, p < 0.01), and reduced KT‐arthrometer evaluation (1.6 vs 2.6, p < 0.01). Combined ACL + ALL reconstruction resulted in improved IKDC scores (92.5 vs 87.8, p < 0.01), Lysholm scores (95.7 vs 91.2, p < 0.01) and Tegner scores (6.7 vs 5.7, p < 0.01). There was no significant difference in rate of return to play at the same level (54.3% vs 46.0%, n.s.). ConclusionThe current evidence suggests alongside soft tissue graft ACL reconstruction that concomitant ALL reconstruction improves clinical outcomes, with improved knee stability and lower re‐rupture rates. Level of evidenceIII.

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Purpose The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following arthroscopic Bankart repair, and to evaluate factors associated with satisfaction and shoulder function, as deined by subjective shoulder value. Methods A retrospective review of athletes who underwent arthroscopic Bankart repair, with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), satisfaction, and whether they would undergo the same surgery again, and rate, level and timing of return to play, and Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Multi-linear regression models were used to evaluate factors afecting postoperative Satisfaction, and SSV level. Results Overall, 144 athletes who underwent arthroscopic Bankart repair were included, with a mean age of 26.9 years (SD: 8.1), 132 (91.7%) were males, and mean follow-up of 75.7 months. At inal follow up, 82.6% were satisied/very satisied, and the mean SSV was 85.8 (SD: 14.4). Overall, the rate of return to play was 80.5%, with 63.9% returning at the same level at a mean of 6.2 months (SD: 2.7). Overall, there was 18 (12.5%) had recurrent instability, and a further procedure was performed in 15 (10.4%) patients. Linear regression revealed that the SIRSI score (p < 0.0001), SSV (p < 0.0001), VAS (p < 0.0031), no sleep trouble (p = 0.0129) was associated with satisfaction. Logistic regression revealed whether a patient required revision surgery (p = 0.0029), or had re-dislocation (p = 0.0031) was also associated with satisfaction. Linear regression revealed that the SIRSI score (p < 0.0001), VAS score (p < 0.0001), and no sleep trouble (p < 0.0001), were associated with SSV score. Conclusion There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes and a high rate of return to play among athletes. However, there was a moderate rate of recurrent instability and further revision surgery. This study identiied that the SIRSI score, VAS score, no sleep trouble and ability to return to play at the same level were associated with both satisfaction and SSV score. Level of evidence III.