Author Reply to ”Regarding ‘Augmentation of Anterolateral Structures of the Knee Causes Undesirable Tibiofemoral Cartilage Contact in Double-Bundle Anterior Cruciate Ligament Reconstruction—A Randomized In-Vivo Biomechanics Study’”

Editorial Commentary: Nonanatomic Lateral Extra-Articular Procedures Performed at the Time of Anterior Cruciate Ligament Reconstruction Risk Overconstraint: Anatomic Anterolateral Ligament Reconstruction Does Not

“…Indeed, it is not clear from the current article exactly what structure the authors intended to reconstruct, but in a recent letter to the editor regarding a different study from the same institution, 2 the authors reported that their augmentation procedure "was based on the concept of the rotatory functional restoration, neglecting the precise anatomy of the ALL [anterolateral ligament] or ALC [anterolateral complex]." 3 The authors' justification for this procedure was their belief that "the clinical effect of the lateral extra-articular procedure is not ascertained." 3 I disagree with this statement on the basis that there are numerous comparative studies reporting significant benefits of combined ACL-ALL reconstruction 4 (including studies of young patients participating in pivoting or contact sports, 5 professional athletes, 6 patients undergoing revision ACL reconstruction, 7 patients with chronic injuries, 8 patients with hyperlaxity, 9 and patients undergoing medial meniscal repair 10,11 ).…”

“…3 The authors' justification for this procedure was their belief that "the clinical effect of the lateral extra-articular procedure is not ascertained." 3 I disagree with this statement on the basis that there are numerous comparative studies reporting significant benefits of combined ACL-ALL reconstruction 4 (including studies of young patients participating in pivoting or contact sports, 5 professional athletes, 6 patients undergoing revision ACL reconstruction, 7 patients with chronic injuries, 8 patients with hyperlaxity, 9 and patients undergoing medial meniscal repair 10,11 ). The SANTI (Scientific ACL Network International) Study Group has also recently shown that isolated ACL reconstruction is associated with a risk of graft rupture that is more than 5-fold higher than that of combined ACL-ALL reconstruction at a mean followup of greater than 100 months.…”