Anterolateral Ligament Reconstruction Does Not Delay Functional Recovery, Rehabilitation, and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Matched-Pair Analysis From the SANTI (Scientific ACL Network International) Study Group

Abstract

Purpose To determine whether the addition of an anterolateral ligament reconstruction (ALLR) resulted in delayed functional recovery (based on the Knee Santy Athletic Return to Sport [K-STARTS] score) at 6 months after anterior cruciate ligament reconstruction (ACLR). Methods A retrospective analysis of prospectively collected data from consecutive patients who underwent an ACLR between September 2017 and December 2020 was conducted. Patients who received an isolated hamstring autograft (isolated ACLR group) were propensity matched in a 1:1 ratio to patients who received a hamstring autograft ACLR combined with an ALLR (ACLR-ALLR group). Outcome measures included the Tegner Activity Scale and the K-STARTS test—a validated composite return-to-sports test (including the Anterior Cruciate Ligament–Return to Sport After Injury scale, Qualitative Assessment of Single-Leg Landing tool, limb symmetry index, and ability to change direction using the Modified Illinois Change of Direction Test). Results The study included 111 matched pairs. At 6 months postoperatively, there were no significant differences between groups in the overall K-STARTS score (65.4 for isolated ACLR vs 61.2 for ACLR-ALLR, P = .087) or the Tegner Activity Scale score (3.7 for isolated ACLR vs 3.8 for ACLR-ALLR, P = .45). In addition, an evaluation of the subscales of the K-STARTS score revealed no disadvantage across the domains of neuromuscular control, limb symmetry index, agility, or psychological readiness to return to sport when an ALLR was performed. Conclusions The addition of ALLR at the time of ACLR does not delay functional recovery. Specifically, at 6 months postoperatively, there was no disadvantage in patients undergoing ALLR-ACLR, when compared with those undergoing isolated ACLR, with respect to neuromuscular control, limb symmetry indices (hop tests), agility, or psychological readiness to return to sport. Level of Evidence Level III, retrospective comparative study.

Addition of anterolateral ligament reconstruction to primary anterior cruciate ligament reconstruction could benefit recovery of functional outcomes

“…In the present study, there was no difference in LSI for quadriceps and hamstring between the two group at 6 and 12 months. Our findings are consistent with the result of a previous study 46 . However, the combined ACLR and ALLR group showed better SLHD at 6 and 12 months postoperative than isolated ACLR group.…”

Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes

“…It is possible that the strict criteria for a return to sport used in this study were responsible for the low rate of return to sport. In addition, Coquard et al [13] observed that adding an ALL reconstruction to a HT ACL graft does not delay functional recovery and return to sport. Some surgeons are concerned about doing ALL reconstructions because of a presumed higher risk of complications.…”

Comparison of ACL and Anterolateral Ligament Reconstruction With Isolated ACL Reconstruction Using Hamstring Autograft: Outcomes in Young Female Patients With High-Grade Pivot Shift

“…A matched-pair analysis from the Scientific ACL Network International Study Group reported that additional ALLR did not delay functional recovery and did not have disadvantages in neuromuscular control, agility, or psychological readiness to RTS at 6 months postoperatively. 15 …”