Clinical Outcomes After Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction

Abstract

Background:Graft rupture rate, return to sport and persistent rotational instability remain a concern postoperatively following anterior cruciate ligament (ACL) reconstruction. The anterolateral ligament (ALL) has recently been shown to act as a lateral knee stabilizer that helps improve rotational stability. To improve functional and clinical outcomes, a combined ACL reconstruction with an associated ALL reconstruction has been proposed.Purpose:The main purpose of this study was to evaluate the clinical outcomes of the combined ACL and ALL reconstruction.Methods:A literature search in PubMed was performed and papers reporting on clinical outcomes after combined ACL and ALL reconstruction were identified. The inclusion criteria was a minimum 2-year follow-up.Results:Five studies were included in the review. The overall graft failure rate in patients with ACL and ALL reconstruction was <3% at 2 years minimum after surgery. Comparison analysis in a high-risk population demonstrated that the graft failure rate in combined ACL and ALL reconstruction was 2.5 times lower than with isolated bone-patella tendon-bone graft and 3.1 times lower than with isolated hamstring graft. The medial meniscal repair failure rate was also 2 times lower in the combined ACL and ALL reconstruction group compared with isolated ACL reconstruction. Return to sport and functional outcomes did not show any significant difference between the groups. The rate of reoperations was not increased in patients with combined ACL and ALL reconstruction.Conclusions:Overall, combined ACL and ALL reconstruction provides promising results that may improve graft rupture rates and meniscal repair failure rates, while maintaining excellent functional outcomes.

Comparison of the outcomes of isolated anterior cruciate ligament reconstruction and combined anterolateral ligament suture tape augmentation and anterior cruciate ligament reconstruction

“…However, five of the patients in the combined ALL and ACL reconstruction group in their study had a pivot shift of grade 1 or 2, and four had an IKDC score of C at the final follow-up. On the other hand, none of the patients in the ALL STA group in our study had a pivot shift of grade 1 or 2 at the final follow-up, and none had an IKDC score of C. Delaloye et al [27] demonstrated that compared with ACL reconstruction only, combined ACL and ALL reconstruction in a high-risk population is associated with significantly decreased graft rupture rates. Marcacci et al [28] reported a graft rupture rate of 2%.…”

“…Delaloye et al[ 27 ] demonstrated that compared with ACL reconstruction only, combined ACL and ALL reconstruction in a high-risk population is associated with significantly decreased graft rupture rates. Marcacci et al[ 28 ] reported a graft rupture rate of 2%.…”

Correlation Analysis of the Anterolateral Ligament Length with the Anterior Cruciate Ligament Length and Patient’s Height: An Anatomical Study

“…62 proposed chronic ACL lesion, the presence of a grade 3 pivot shift, participation in high level sports, an associated Segond fracture or a lateral femoral notch sign on conventional radiographs as indications for combined ACL and ALL reconstruction. In technical notes, the use of iliotibial tract 63 and gracilis autografts 64 as well as arthroscopic ALL identification 65 have been described. Sonnery-Cottet and colleagues 20 re-evaluated the subjective outcomes following combined ACL and ALL reconstruction in 83 patients and reported no specific complications in their sample after a minimum follow-up of two years.…”

Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: A meta-analysis

“…The addition of an ALL reconstruction demonstrated a very low complication rate (0.5%) related to the ALL graft. 49 Some specific complications of ALL reconstruction were observed in included studies, such as pretibial…”