Does anterolateral ligament internal bracing improve the outcomes of anterior cruciate ligament reconstruction in patients with generalized joint hypermobility?

Abstract

The anterolateral ligament (ALL) has been identified as a supporter to the anterolateral rotational stability of the knee joint, and it has a strong association with ACL ruptures. [4][5][6] Ferretti et al. [7] reported that approximately 90% of ALL injuries are associated with ACL tears, and due to this strong relationship, recent studies have focused on clearly demonstrating the biomechanical and anatomical features of the ALL. In a recent biomechanical study, Nitri et al. [8] reported that concurrent ACL reconstruction and ALL reconstruction significantly improve the rotatory stability of the knee compared with ACL reconstruction only.

Comparison of Anterior Cruciate Ligament Reconstruction With Versus Without Anterolateral Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…All 14 studies were RCTs with an evidence level of 1. As determined by the Jadad scale, the score of included RCTs ranged from 2 to 6 points, with 10 studies § being of high quality (Jadad score ≥4) and 4 studies 1 , 19 , 53 , 59 being of poor quality (Jadad score <4).…”

“…The nature of the different interventions typically made the blinding of patients and surgical personnel effectively impossible. A blinded assessment of outcomes was used by some studies 6 , 13 , 14 , 19 , 44 , 56 , 59 to partially avoid this potential source of bias, while some studies 1 , 7 , 36 , 53 , 54 , 60 did not provide comprehensive blinding details, and one study 29 mentioned that the outcome assessment was not blinded. One study 6 lost more than 20% of patients during follow-up and was considered to have a high risk of attribution bias.…”

“…One study 6 lost more than 20% of patients during follow-up and was considered to have a high risk of attribution bias. There were 5 studies 6 , 36 , 44 , 53 , 56 that were rated as having a high risk of other sources of bias. The sources of bias included the following: the method of grouping introduced another element of variability or the included participants were either all female or all male.…”

“…The outcomes of the Lachman test were divided into good results (ie, normal and nearly normal) and poor results (ie, abnormal and severely abnormal). Overall, 8 studies 1 , 6 , 7 , 14 , 19 , 53 , 56 , 60 (308 patients for isolated ACLR and 304 patients for ACLR+ALA) reported postoperative Lachman scores. No significant heterogeneity was found ( I 2 = 0%; P = .93).…”

Resultados da reconstrução do ligamento cruzado anterior em pacientes com lesão associada do ligamento anterolateral

“…Por se tratar de uma estrutura caracterizada recentemente, a literatura mostra claramente a necessidade de seguimento mais prolongado para a averiguação da presença ou não de benefícios no longo prazo da reconstrução combinada dos ligamentos analisados, e com estudos clínicos prospectivos randomizados e controlados com grande número de pacientes. 1,9,[14][15][16]20,24,25 Este estudo apresenta algumas limitações importantes. Por se tratar de um estudo retrospectivo, há risco de alguns vieses típicos de um estudo não prospectivo, e um maior número de casos seria o mais indicado para aumentar o poder da análise estatística e demonstrar possíveis diferenças entre os grupos.…”