Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction

Helito, Camilo Partezani; Camargo, Danilo Bordini; Sobrado, Marcel Faraco; Bonadio, Marcelo Batista; Giglio, Pedro Nogueira; Pécora, José Ricardo; Camanho, Gilberto Luís; Demange, Marco Kawamura

doi:10.1007/s00167-018-4934-2

Cited by 118 publications

(142 citation statements)

References 45 publications

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“…17 To the knowledge of the authors, Helito et al report the only study that specifically investigates this topic. 18 At a final follow-up ranging between 24 and 29 months, patients who underwent ACL þ ALL reconstruction demonstrated less residual pivot shift (9.1 vs. 35.3%, p ¼ 0.011), better KT-1000 (1 vs. 2, p ¼ 0.048) and better results on both IKDC (92.7 AE 5.9 vs. 87.1 AE 9.0, p ¼ 0.0013) and Lysholm (95.4 AE 5.3 vs. 90.0 AE 7.1, p < 0.0001) evaluations (►Table 1). Even though patients from the ALL group exhibited a lower rerupture rate, the difference was not statistically significant.…”

Section: Allr Is Associated With Improved Outcomes In Patients With Cmentioning

confidence: 99%

“…It is important to note that the reasons for widespread abandonment of LEAP some 30 years ago, including high rates of knee stiffness and reoperations, 31,32 were not observed in any of the clinical series reporting outcomes of ALLR. 5,11,18,24,28 However, because of these concerns, Thaunat et al analyzed complications and reoperations after combined ACLR þ ALLR in the largest published series of any type of a LEAP specifically evaluating for adverse outcomes. In this series of 548 patients, only three reoperations were specifically related to the ALL procedure, and all required removal of the femoral screw.…”

Section: Other Noncomparative Series and Key Case Reports Reoperationmentioning

confidence: 99%

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Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group

et al. 2020

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Lateral extraarticular procedures (LEAPs) in the anterior cruciate ligament (ACL)-injured knee were widely abandoned in the 1990s but have seen a recent resurgence. The aim of this review was to demonstrate that anterolateral ligament reconstruction (ALLR) is associated with evidence of significant advantages and no evidence of historical concerns. A narrative review of the literature was performed. Combined ACL + ALLR is associated with improved outcomes when compared against isolated ACL reconstruction, including a significantly lower risk of ACL graft rupture (hazard ratio [HR]: 0.327, 95% CI: 0.130–0.758), a significantly lower risk of reoperation for secondary meniscectomy following medial meniscal repair at the time of ACL reconstruction (HR: 0.443, 95% CI: 0.218–0.866), significantly increased likelihood of return to the preinjury level of sport following primary (odds ratio [OR]: 1.938, 95% CI: 1.174–3.224) and revision ACL reconstruction (57.1 vs. 25.6%, respectively; p = 0.008), and in chronic ACL injuries, less residual pivot shift (9.1 vs. 35.3%, p = 0.011), and better IKDC (92.7 ± 5.9 vs. 87.1 ± 9.0, p = 0.0013) and Lysholm (95.4 ± 5.3 vs. 90.0 ± 7.1, p < 0.0001) scores, and no evidence of historical concerns. Combined ACLR + ALLR is associated with excellent clinical outcomes with no evidence of the adverse events that led to the historical widespread abandonment of other types of LEAP. Specifically, comparative series have demonstrated significant advantages of ALLR when compared against isolated ACLR with respect to reduced rates of ACL graft rupture, secondary meniscectomy, persistent instability, and significantly improved functional outcomes and improved return to sport metrics.

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Section: Allr Is Associated With Improved Outcomes In Patients With Cmentioning

confidence: 99%

Section: Other Noncomparative Series and Key Case Reports Reoperationmentioning

confidence: 99%

Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group

et al. 2020

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“…To date, only few studies reported the clinical outcomes of ALL reconstruction since the rediscovery of this ligament [32,33,36,50]. In a retrospective case series, Sonnery-Cottet et al [36] evaluated 92 patients at a minimum 2-year follow-up after concomitant ACL and ALL reconstruction.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…Another randomized study showed an improvement in knee laxity measured using a KT-1000 arthrometer in patients with combined ACL and ALL reconstructions compared to patients with isolated ACL reconstructions; however, the other measured parameters did not differ significantly [32]. Recently, Helito et al [50] evaluated the results of combined ACL-ALL reconstruction with isolated ACL reconstruction in 101 chronic ACL injuries. Regarding functional outcome scores, they found better results on both the IKDC and the Lysholm evaluations in combined ACL-ALL reconstruction group.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Decision-Making for ALL Reconstruction and Surgical Techniques

Gürpınar¹

2020

Knee Surgery - Reconstruction and Replacement

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The anterolateral ligament (ALL), which was first described in 1879, was reintroduced in 2013 by Claes et al. It originates near the lateral epicondyle of the distal femur, runs along the lateral outer aspect of the knee, and inserts on the proximal tibia between Gerdy's tubercle and fibular head. The ALL tightens when the knee is internally rotated (twisted inwards), and in doing so, it is proposed to be a stabilizer to internal tibial rotation. Biomechanical studies showed that the ALL restrains internal rotation of the tibia and thus affects the pivot-shift phenomenon in the anterior cruciate ligament (ACL)-injured knee. Therefore, it is proposed that the deficient ALL can be a reason for persistent rotatory instability after ACL reconstruction. Furthermore, ALL reconstruction techniques have evolved and indications extended. Commonly accepted indications for concomitant ACL and ALL reconstruction are ACL revisions, high-grade pivot-shift test, chronic ACL rupture, and young patients and patients doing pivoting activities. Most surgeons perform an anatomic reconstruction technique with gracilis autograft. However, only few studies published reporting the outcomes of ALL reconstruction and more studies with longer follow-up times are, therefore, needed to provide the compelling clinical evidence for the efficacy of concomitant ACL and ALL procedures.

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“…Controversy was found regarding anatomy, 1,2,4-6 histology, 7-9 biomechanics, [10][11][12][13] radiological evaluation, [14][15][16][17][18][19][20] and reconstruction techniques. [21][22][23][24][25] Even though we have some data showing the benefits of ALL reconstruction, [26][27][28][29][30] it is not an absolute truth for most knee surgeons. But, as pointed out recently by Rossi in an Arthroscopy editorial (and matching my personal opinion), "The story is not any more 'if' augmentation should be considered but 'when' and, maybe more important, 'how' to augment."…”

Section: See Related Article On Page 2152mentioning

confidence: 99%

Editorial Commentary: Extension of Knowledge—and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near Extension

Helito¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The knee anterolateral ligament (ALL) is one of the most hotly debated topics in sports medicine in the last decade. Once one aspect of discussion regarding the ALL reaches a consensus, attention immediately turns to the next one. This has already happened with the existence of the ALL itself, its anatomic features, the ability to visualize the ALL with magnetic resonance imaging, and many other topics. In the end, the most important aspect must be clinical outcomes, and existing studies are trying to find the optimum surgical technique to best restore knee stability and reduce failure rates. It appears that, when doing an anatomic ALL reconstruction, fixation must be performed in full extension. The literature regarding ALL reconstruction shows promising results, with a strong tendency to present better knee stability, improved functional scores, and lower failure rates.

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Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction

Abstract: Level III.

Cited by 118 publications

References 45 publications

Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group

Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group

Decision-Making for ALL Reconstruction and Surgical Techniques

Editorial Commentary: Extension of Knowledge—and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near Extension

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