Anterolateral ligament reconstruction improves the clinical and functional outcomes of anterior cruciate ligament reconstruction in athletes

Abstract

Purpose To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deicient knees. The objective of this study was to improve knowledge regarding the treatment of ACL-deicient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). Methods One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A (n = 54) underwent ACLR, while those in group B (n = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18-40) and 24 (18-33) years in groups A and B, respectively, and the median followup was 60 (55-65) months. Physical examination indings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. Results One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively (p < 0.001). The median instrumented knee laxity was 2.5 ± 0.7 (1.2-6.1) mm in patients in group A and 1.2 ± 0.7 (1.2-3.2) mm in patients in group B (p < 0.001). Additionally, 44 (84.6%) patients in group A had normal IKDC scores and 3 (5.8%) had nearly normal scores, while 48 (96.0%) patients in group B had normal IKDC scores and 2 (4%) had nearly normal scores (p < 0.001). Conclusion Combined ACL and ALL reconstruction, compared with isolated ACLR resulted in favourable clinical and functional outcomes, as demonstrated by decreased rotational instability and instrumented knee laxity, a lower graft rupture rate and better postoperative IKDC scores. Level of evidence 1.

A Systematic Review of Randomized Controlled Trials in Anterior Cruciate Ligament Reconstruction: Standard Techniques Are Comparable (299 Trials With 25,816 Patients)

“…Hamido et al. 34 randomized 107 male athletes and reported reduced instrumented knee laxity and a lower rate of graft failure with the added anterolateral ligament reconstruction at 60 months’ follow-up.…”

“…A further 3 RCTs compared the combined anterolateral ligament reconstruction with ACLR compared with ACLR alone, with 1 trial reporting significant differences. Hamido et al 34 randomized 107 male athletes and reported reduced instrumented knee laxity and a lower rate of graft failure with the added anterolateral ligament reconstruction at 60 months' follow-up.…”

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

“…Indeed, the Stability study 40 has shown that adding a LEAT to an anatomical ACL reconstruction reduces the risk of clinical failure by 38% and graft rupture by 67% as compared with ACL reconstruction alone. In line with the renewed interest in LEAT, clinical studies [41][42][43][44] have reported the results of combined ACL and ALLR, suggesting superior outcomes when compared with ACL reconstruction alone. In patients displaying high-grade pivot-shift, the addition of LEAT 45 46 or ALLR 47 48 seem to result in significant improvement in controlling rotational laxity.…”

Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery

“…Previous biomechanical studies have shown that the addition of ALL reconstruction to ACL reconstruction for ACL and ALL deficient knees improves rotational instability [ 22 , 31 ]. Moreover, combined ACL and ALL reconstruction has been reported as an effective approach for lowering the rate of graft failure when compared to ACL reconstruction alone [ 8 , 10 , 27 ]. Double-bundle ACL reconstruction has been also reported to be associated with superior knee stability (both anterior and rotational stability) than single-bundle reconstruction, while subjective scorings have showed no statistical differences [ 18 ].…”