Anterolateral Complex Reconstruction: Another Fad or Method to Improve ACL Outcomes?

Abstract

Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not always reflected in clinical outcome trials. Additional procedures also come with additional costs and further economic analysis needs to be performed to clarify whether these additional costs are offset by improved clinical and societal outcomes in the longer-term.

Reconstruction for Chronic ACL Tears with or without Anterolateral Structure Augmentation in Patients at High Risk for Clinical Failure

“…Helito et al 24 reported no cases of rerupture after combined reconstruction; however, they reported a higher positive pivot shift rate (9.1%). With the recognition of the anterolateral ligament as a distinct structure away from the central pivot of the knee and reconstruction of this structure 30,47 , the reported graft failure rates were decreased significantly compared with isolated ACLR, while the residual positive pivot-shift rates remained relatively high in the previous studies. The discrepancy indicated that the augmented anterolateral structure potentially would be more effective as an additional restraint to anterolateral rotation instability as it was parallel to the ACL posterolateral bundle (Fig.…”

Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament‐ (ACL‐) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors

“…Yasuma et al also reported an increased knee rotatory laxity in six fresh-frozen cadavers in the presence of anterolateral structure tears [23]. On the other hand, other authors [24][25][26][27][28][29] that compared the effect of an isolated ALL and iliotibial band resection in an ACL-intact knee did not report significant correlations with tibiofemoral compartment subluxation during a simulated pivot-shift, thus suggesting that the ALL does not represent a primary restraint to the pivot-shift test. The heterogeneous results might be due to the different setups adopted, the age of the specimens and relative quality of the knee structures, and the instrumented device used for the quantitative assessment.…”