Combined anterior cruciate ligament revision with reconstruction of the antero‐lateral ligament does not improve outcome at 2‐year follow‐up compared to isolated acl revision; a randomized controlled trial

Abstract

Purpose It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. Methods The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (− ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. Results A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the − ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. Conclusion Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. Level of evidence Level I.

Single‐ or two‐stage revision after failed ACL reconstruction: No differences in re‐revision rates and clinical outcomes

“…These data are not available in the registry. However, the impact of ALL stabilisation in revision ACL surgery has been questioned in a recently published randomised controlled trial found no difference in clinical and subjective outcomes after isolated ACL revision with or without ALL in a cohort of ACL revision patients [12]. Finally, the completeness of the stabilityrelated clinical outcome parameters at the 1-year follow-up was low (28-34%).…”

Dynamic radiostereometry can objectively quantify the kinematic laxity patterns and rotation instability of the knee during a pivot‐shift test

“…The anterolateral ligament (ALL) is a capsular reinforcement located between the Gerdy's tubercle and lateral femoral condyle, which contributes to internal knee rotation stabilisation [45]. However, the effect of ALL reconstruction on internal knee rotation stabilisation has shown diverging results [17,45,47,51].…”