The Addition of Either an Anterolateral Ligament Reconstruction or an Iliotibial Band Tenodesis Is Associated With a Lower Failure Rate After Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Trial

Helito, Camilo Partezani; Sobrado, Marcel Faraco; Silva, Andre Giardino Moreira da; Pádua, Vitor Barion Castro de; Guimarães, Tales Mollica; Bonadio, Marcelo Batista; Pécora, José Ricardo; Gobbi, Riccardo Gomes; Camanho, Gilberto Luís

doi:10.1016/j.arthro.2022.06.039

Cited by 29 publications

(47 citation statements)

References 46 publications

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“…The graft rupture rate was around 3% in our study, which is similar to the 2.6% rate reported by Thaunat et al, 44 2.3% rate reported by Helito et al, 19 and 1.3% rate reported by Pioger et al 29 after a minimum follow-up of 2 years. This demonstrates that combined ACL/ALL reconstruction protects the ACL graft during the healing phase, 6 because the failure rate of isolated ACL reconstruction can reach 10% or higher in selected high-risk populations.…”

Section: Discussionsupporting

confidence: 91%

“…Importantly, the outcomes at a mean follow-up of 3 years (CG: SD, 9.6 months; SG: SD, 8.1 months) after combined ACL/ALL reconstruction when using either technique are comparable with the previously published outcomes, 29,31,39,44 which is further evidence that our findings are valid. The graft rupture rate was around 3% in our study, which is similar to the 2.6% rate reported by Thaunat et al, 44 2.3% rate reported by Helito et al, 19 and 1.3% rate reported by Pioger et al 29 after a minimum follow-up of 2 years. This demonstrates that combined ACL/ALL reconstruction protects the ACL graft during the healing phase, 6 because the failure rate of isolated ACL reconstruction can reach 10% or higher in selected high-risk populations.…”

Section: Discussionsupporting

confidence: 91%

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Comparison Between Continuous and Separate Grafts for ALL Reconstruction When Combined With ACL Reconstruction: A Retrospective Cohort Study From the SANTI Study Group

Ripoll,

Moreira da Silva,

Saoudi

et al. 2023

Am J Sports Med

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Background: While various techniques have been described to augment the anterolateral side of the knee, such as lateral extra-articular tenodesis and anterolateral ligament (ALL) reconstruction (ALLR), it is unclear how they affect clinical outcomes. The aim of this study was to compare the results of 2 ALLR techniques for combined anterior cruciate ligament (ACL)/ALL reconstruction. Hypothesis: The graft rupture rate, complications, and patient-reported outcomes are similar between a reconstruction technique using a continuous gracilis graft (CG) and single femoral tunnel for ACL/ALL reconstruction, and one using a separate gracilis graft (SG) and independent femoral tunnels. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of data collected prospectively at 2 hospitals was conducted: one in which a CG is preferred when performing combined ACL/ALL reconstruction and the other in which an SG is preferred. The medical records at these 2 hospitals were searched to identify ACL-deficient patients who had undergone ACL/ALL reconstruction between 2015 and 2020. Eligible patients were between 18 and 60 years of age, had the reconstruction surgery done within 24 months of the injury, and had ≥2 years of follow-up. The eligible patients were contacted to gather outcomes, or their outcomes were collected in person during their last follow-up visit. Outcomes evaluated included graft rupture rate, complication rate, and Lysholm and International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores. Preoperative and intraoperative data were also evaluated. Results: A total of 237 patients were available for analysis in the GC group and 178 in the SG group with a mean follow-up of 3 years (CG: SD, 9.6 months; SG: SD, 8.1 months). The authors found a low rate of graft rupture (CG: 3.4%; SG: 2.8%; P = .785) and no difference between techniques. The complication rate was 6% in the CG group, while it was 10% in the SG group ( P = .112). The mean value of the IKDC-SKF was similar between techniques (CG: 88.1; SG: 87.9; P = .267), and the mean Lysholm score was excellent in both sets of patients (CG: 90.0; SG: 92.4; P < .001). Conclusion: This study found little to no difference in the graft rupture rate, complication rate, and functional knee scores when using a CG or SG for ALLR during combined ACL/ALL reconstruction. Both techniques are equivalent and can be used for an anterolateral augmentation procedure in combination with ACL reconstruction.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Comparison Between Continuous and Separate Grafts for ALL Reconstruction When Combined With ACL Reconstruction: A Retrospective Cohort Study From the SANTI Study Group

Ripoll,

Moreira da Silva,

Saoudi

et al. 2023

Am J Sports Med

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Sørensen,

Faunø,

Konradsen

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. Methods The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (− ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. Results A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the − ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. Conclusion Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. Level of evidence Level I.

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“…9,18,27,61 Three studies described the initial primary graft, 18,25,56 of which the hamstring autograft was the most common in 2 studies. 18,25 Six studies described the extent of knee laxity before revision, 2,9,18,27,48,61 with 4 studies primarily investigating higher-grade (2) pivot shift. 2,18,27,61 Five studies reported on their rehabilitation protocol.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…18,25 Six studies described the extent of knee laxity before revision, 2,9,18,27,48,61 with 4 studies primarily investigating higher-grade (2) pivot shift. 2,18,27,61 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).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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

et al. 2023

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Background: After its success in restoring rotational stability and reducing failure rates in primary anterior cruciate ligament reconstruction (ACLR), lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR) has been endorsed for use in revision ACLR surgery, where failure rates are historically higher. Purpose: To perform a systematic review and meta-analysis on whether the addition of a LET or ALLR results in superior clinical outcomes and stability compared with isolated revision ACLR (iACLR). Study Design: Meta-analysis; Level of evidence, 4. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis of comparative studies using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (“extra-articular” OR “tenodesis” OR “anterolateral ligament” OR “iliotibial”) AND (“anterior cruciate ligament”) AND (“revision” OR “re-operation”). Data pertaining to all patient-reported outcome measures (PROMs), rotational stability, and postoperative complications were extracted from each study. Results: After abstract and full-text screening, 10 clinical comparative studies were included. There were 793 patients, of whom 390 had an iACLR while 403 had an ACLR augmented with a LET or an ALLR (augmented ACLR [aACLR]). The mean time for assessment of PROMs was 35 months. The aACLR group had superior International Knee Documentation Committee (IKDC) scores (standardized mean difference [SMD], 0.27; 95% CI, 0.01 to 0.54; P = .04), rotational stability (odds ratio [OR], 2.77; 95% CI, 1.91 to 4.01; P < .00001), and lower side-to-side difference (OR, −0.53; 95% CI, −0.81 to −0.24; P = .0003) than those without the augmentation. Furthermore, they were less likely to fail (OR, 0.44; 95% CI, 0.24 to 0.80; P = .007). Subgroup analysis in the higher-grade laxity cohort (grade ≥2) revealed an even greater IKDC score (SMD, 0.51; 95% CI, 0.16 to 0.86; P = .005) and an improved Lysholm score (SMD, 0.45; 95% CI, 0.24 to 0.67; P < .0001) in the aACLR group. Conclusion: Revision aACLR with a LET or an ALLR can improve subjective IKDC scores, restore rotational stability, and reduce failure rates compared with iACLR. Although controversy remains on the necessity of augmenting all revision ACLRs, the present meta-analysis advocates adding a lateral procedure, particularly in those with a higher-grade pivot shift.

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The Addition of Either an Anterolateral Ligament Reconstruction or an Iliotibial Band Tenodesis Is Associated With a Lower Failure Rate After Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Trial

Cited by 29 publications

References 46 publications

Comparison Between Continuous and Separate Grafts for ALL Reconstruction When Combined With ACL Reconstruction: A Retrospective Cohort Study From the SANTI Study Group

Comparison Between Continuous and Separate Grafts for ALL Reconstruction When Combined With ACL Reconstruction: A Retrospective Cohort Study From the SANTI Study Group

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

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

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