Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis

Abstract

Objectives To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. Methods A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were “anterior cruciate ligament” OR “acl” AND “anterolateral ligament” AND “reconstruction.” Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use “anatomical” techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p < 0.05. Results Ten articles were selected, with a total of 1495 patients, most of whom were men, of whom 674 submitted to ACL and ALL reconstruction and 821 to isolated ACL reconstruction. Combined ACL and ALL reconstruction exhibited a statistically significant advantage in residual pivot shift (RR 0.34, 95% CI 0.24–0.47, I2 = 0%, p < 0.01), rerupture rate (RR 0.34, 95% CI 0.19–0.62, I2 = 0%, p < 0.01), Lachman test (RR 0.59, 95% CI 0.40–0.86, I2 = 21%, p < 0.01), and postoperative Lysholm score (MD 2.28, CI 95% 0.75–3.81, I2 = 73%, p < 0.01). Conclusions Combined ACL and ALL reconstruction obtained better postoperative clinical outcomes when compared with isolated ACL reconstruction, especially in reducing residual pivot shift and rerupture rate.

Determining the Substantial Clinical Benefit Values for Patient-Reported Outcome Scores After Primary ACL Reconstruction

“…In recent decades, patient-reported outcomes (PROs) have been used to help assess the postoperative status of patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). 3 , 4 , 12 , 28 , 33 Even if these PROs indicate a statistically significant improvement postoperatively, the data may not be clinically relevant or meaningful to patients. Consequently, the minimal clinically important difference (MCID) was proposed for the evaluation of meaningful outcome improvement, defined as the least difference in outcome perceived as clinically important by the patient.…”

Anterior Cruciate Ligament Reconstruction with Autologous Hamstring Single- versus Double-Bundle Graft: A Prospective Study with 10-Year Follow-up

“…In the last decade, several authors conferred a relevant role of the AL ligament (ALL) in rotatory knee stability control, 45 46 47 even improving results of SB ACL anatomic reconstruction in combined procedure, regarding residual pivot shift, rerupture rate, Lachman's test, and postoperative Lysholm's score. 46 Kawanishi et al 47 showed that the combination of ALL reconstruction (ALLR) to primary DB ACLR improved residual knee instability, being effective in preoperative grade-3 subjective pivot shift. At 2-year follow-up, Yoon et al 48 observed significant differences in Lachman's test, pivot shift, and side-to-side difference in stress radiographs comparing SB ACLR and ACLR with ALLR, in patients with grade 2 or more pivot-shift instability.…”

“…20,43,44 Moreover, few prospective randomized trials have been performed regarding this surgical aspect and have demonstrated the importance of the PL bundle to increase the rotational stability. 14 In the last decade, several authors conferred a relevant role of the AL ligament (ALL) in rotatory knee stability control, [45][46][47] even improving results of SB ACL anatomic reconstruction in combined procedure, regarding residual pivot shift, rerupture rate, Lachman's test, and postoperative Lysholm's score. 46 Kawanishi et al 47 showed that the In our study, the anteroposterior laxity, measured with Telos stress radiography, showed no statistical difference between the SB and DB techniques.…”

“…14 In the last decade, several authors conferred a relevant role of the AL ligament (ALL) in rotatory knee stability control, [45][46][47] even improving results of SB ACL anatomic reconstruction in combined procedure, regarding residual pivot shift, rerupture rate, Lachman's test, and postoperative Lysholm's score. 46 Kawanishi et al 47 showed that the In our study, the anteroposterior laxity, measured with Telos stress radiography, showed no statistical difference between the SB and DB techniques. However, we observed that A and B outcomes were greater in the DB than in the SB technique, although nonsignificant.…”

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Single Achilles Tendon Allograft: A Technical Note

“…However, some patients continue to complain of residual rotational instability and have difficulties returning to their pre-injury level of sports activities after isolated ACLR [ 3 , 4 , 5 , 6 ]. To address this issue, anterolateral ligament reconstruction (ALLR) has recently attracted interest as a potential solution [ 7 ].…”