Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury

Abstract

Background: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. Purpose: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. Results: A total of 182 patients were evaluated. Postoperative mean ± SD follow-up was 33.6 ± 7.1 and 36.1 ± 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 ± 1.2 mm vs 7.2 ± 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 ± 10.7 vs 89.1 ± 6.6; P = .035) and Lysholm scores (85.9 ± 10.1 vs 92.0 ± 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. Conclusion: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.

Long-term Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

“…5 From a clinical perspective, this results in significant advantages of combined ACLR and anterolateral ligament (ALL) reconstruction (ALLR), including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy (after meniscal repair), improved knee stability, and higher rates of return to preinjury levels of sports. 31 Comparative studies have demonstrated significant advantages 35 in specific populations, including patients with hyperlaxity, 11 patients who have chronic ACL injury, 10 young patients participating in pivoting sports, 37 and patients undergoing revision ACLR. 15 Despite the resurgence in popularity of combined procedures, it is important to highlight that LEAPs were widely abandoned in the 1980s.…”

The Anterolateral Ligament Has Limited Intrinsic Healing Potential: A Serial, 3-Dimensional–Magnetic Resonance Imaging Study of Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group

“…An imaging-proven injury to the ALL has not widely been accepted as an indication, partly because the intrinsic healing potential is not well-understood. However, this is certainly an important area for further study because Sobrado et al 39 recently reported that patients with an imaging-proven ALL injury experienced higher ACL graft rupture rates and worse functional outcomes than patients with isolated ACL injuries.…”

Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis

“…Ferretti et al described that in up to 90% of ACL injured knees, additional lesions were found to the lateral structures [ 9 ]. Inferior clinical results were noted by Sobrado et al when comparing patients with ACL reconstructed knees and concomitant, but untreated ALL lesions to patients treated for isolated ACL ruptures with intact lateral structures [ 52 ]. These clinical studies are supported by overwhelming biomechanical data regarding the role of the ALC as a more efficient lever arm to control the rotatory translation when compared to an isolated ACLR [ 11 , 32 , 39 , 56 ].…”