Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction

Abstract

Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up.

The Role of Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis for Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Comparative Clinical Studies

“…Regarding the MCMS of the 10 included studies, there were a mixture of good-, 2,18,27 fair-, 9,28,48,56,61 and poor-quality studies. 25,58 The overall quality of the studies was fair (mean score, 63.2).…”

“…Five studies reported on their rehabilitation protocol. 18,27,28,58,61 All studies differed from each other in regard to full weightbearing, degree of knee motion, and return to sport (RTS).…”

“…Six studies compared iACLR ± LET augmentation, 2,9,25,48,56,58 3 ± ALLR, 27,28,61 and 1 ± LET or ALLR. 18 In 5 studies, there were different harvesting options, 2,9,18,56,61 and in the cases where they were described, they were similarly distributed between groups.…”

“…9,18,61 Two studies used contralateral hamstring autograft, 48,58 1 ipsilateral bone–patellar tendon–bone (BPTB) autograft, 25 and 2 tibialis anterior allograft. 27,28…”

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

“…Recently, Boksh et al [44] investigated the effect of an anterolateral supplemental procedure in revision ACL‐R in a meta‐analysis. They included 10 comparative studies with a total of 793 patients [26, 31, 42, 45–51] and concluded that a lateral extra articular augmentation in ACL revision surgery could improve rotational stability, subjective IKDC scores, and reduce graft failure rate compared to isolated ACL revision.…”