Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction

Abstract

Recently described in the medical literature, the anterolateral ligament of the knee is already considered an important stabilizer against the anterolateral tibial rotation, affecting the pivot shift in the failure of the anterior cruciate ligament and behaving as an important secondary rotational stabilizer. The mechanism of anterolateral ligament injury combined with anterior cruciate ligament injury is similar to the mechanism of anterior cruciate ligament injury alone. Thus, the main objective of the joint reconstruction of anterior cruciate ligament and anterolateral ligament would be increased rotational control and prevention of anterior cruciate ligament re-rupture. In view of this importance, the aim of the present study is to summarize the evidence on the main surgical indications described for anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis or anterolateral ligament reconstruction. A review of the literature was conducted in April 2017, through a search of the PubMed, MEDLINE, Cochrane, and Google Scholar databases, with no date limits. After reviewing the main articles in the subject, it was concluded that the main surgical indications described for anterior cruciate reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction are: anterior cruciate ligament revision, physical examination with pivotal shift grade 2 or 3, practice of sport with pivot mechanism and/or high level mechanism, ligament laxity and Segond fracture; Secondly, the following may also be indications: chronic anterior cruciate ligament injury, age less than 25 years old, and radiological sign of lateral femoral condyle depression. However, it is worth mentioning that more studies are still needed to prove these trends.

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

“…33 Specifically, the combined procedure has been demonstrated to significantly reduce the rates of ACL graft rupture 14,18,22,43 and the rates of reoperation for secondary meniscectomy. 41,42 Certain populations have been reported to significantly benefit from combined reconstructions when compared with isolated ACLR (with respect to either knee stability, graft rupture rates, patient-reported outcome measures, and/or return to sport rates), and the use of combined reconstructions has therefore been recommended in young patients (\20 years of age), 1,40,45,49 high-level athletes participating in pivoting sports, 1,40,44,45,49 those with chronic ACL injuries, 1,29,44,45 patients with hyperlaxity, 1,10,18,40,49 and those undergoing revision ACLR. 1,10,22,40,45 The significant advantages of combined reconstruction are attributed to load sharing between the extra-articular and intra-articular reconstructions and more reliable restoration of normal knee biomechanics.…”

Combined Anatomic Anterior Cruciate and Anterolateral Ligament Reconstruction With Quadriceps Tendon Autograft and Gracilis Allograft Through a Single Femoral Tunnel

“…[14][15][16][17][18][19] Numerous different types of LET procedures have been reported, but few are supported by comprehensive reporting of outcomes and explicit reporting of complications. 11,20,21 One of the potential complications is tunnel collision between the ACL reconstruction and LET. This is only a concern when the extra-articular Left knee view.…”

Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation

“…The indications for adding an ALL internal brace (IB) augmentation are a grade 2 or 3 of PS, as evaluated with physical examination under anesthesia, and a tear of the ALL, as evaluated with preoperative 1.5-T MRI. 4 , 5 , 14 , 15 …”