Anterolateral ligament reconstruction improves the clinical and functional outcomes of anterior cruciate ligament reconstruction in athletes

Purpose To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study was to improve knowledge regarding the treatment of ACL-deficient knees with combined ACL...

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Published in:	Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 29; no. 4; pp. 1173 - 1180
Main Authors:	Hamido, Fawzy, Habiba, Abdelrahman A., Marwan, Yousef, Soliman, Aymen S. I., Elkhadrawe, Tarek A., Morsi, Mohamed G., Shoaeb, Wael, Nagi, Ahmed
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2021 Springer Nature B.V
Subjects:	Adolescent Adult Anterior cruciate ligament Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Arthrometry, Articular - methods Athletes Athletic Injuries - surgery Combined Modality Therapy Follow-Up Studies Humans Injuries Joint Instability - diagnosis Knee Knee Joint - surgery Ligaments Ligaments, Articular - surgery Male Medicine Medicine & Public Health Orthopedics Patients Postoperative Period Prospective Studies Rupture - surgery Sports Medicine Treatment Outcome Young Adult ACL repair Knee rotational stability ACL + ALL reconstruction
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Summary:	Purpose To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study was to improve knowledge regarding the treatment of ACL-deficient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). Methods One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A ( n = 54) underwent ACLR, while those in group B ( n = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18–40) and 24 (18–33) years in groups A and B, respectively, and the median follow-up was 60 (55–65) months. Physical examination findings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. Results One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively ( p < 0.001). The median instrumented knee laxity was 2.5 ± 0.7 (1.2–6.1) mm in patients in group A and 1.2 ± 0.7 (1.2–3.2) mm in patients in group B ( p < 0.001). Additionally, 44 (84.6%) patients in group A had normal IKDC scores and 3 (5.8%) had nearly normal scores, while 48 (96.0%) patients in group B had normal IKDC scores and 2 (4%) had nearly normal scores ( p < 0.001). Conclusion Combined ACL and ALL reconstruction, compared with isolated ACLR resulted in favourable clinical and functional outcomes, as demonstrated by decreased rotational instability and instrumented knee laxity, a lower graft rupture rate and better postoperative IKDC scores. Level of evidence 1.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0942-2056 1433-7347
DOI:	10.1007/s00167-020-06119-w