Outcome of a Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Technique With a Minimum 2-Year Follow-up

Background: The anterolateral ligament has recently been identified as an important structure involved in rotational laxity after anterior cruciate ligament (ACL) rupture. Results of a combined ACL and anterolateral ligament (ALL) reconstruction technique have never been reported.

Purpose: To report subjective and objective outcomes after combined ACL and minimally invasive ALL reconstruction with a minimum 2-year follow-up.

Study design: Case series; Level of evidence, 4.

Methods: A total of 92 patients underwent a combined ACL and ALL reconstruction. Indications for a combined procedure were associated Segond fracture, chronic ACL lesion, grade 3 pivot shift, high level of sporting activity, pivoting sports, and radiographic lateral femoral notch sign. Patients were assessed pre- and postoperatively with objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. Instrumented knee testing was performed with the Rolimeter arthrometer. The Knee injury and Osteoarthritis Outcome Score (KOOS) was obtained at the last follow-up. Complications including graft failure or contralateral ACL rupture were also recorded.

Results: The mean follow-up time was 32.4 ± 3.9 months. One patient (1.1%) was lost to follow-up, 1 patient (1.1%) suffered an ACL graft rupture, and 7 patients (7.6%) had a contralateral ACL rupture, leaving 83 patients for final evaluation. At the last follow-up, all patients had full range of motion. The Lysholm, subjective IKDC, and objective IKDC scores were significantly improved (all P < .0001). The Tegner activity scale at the last follow-up (7.1 ± 1.8) was slightly lower than before surgery (7.3 ± 1.7) (P < .01). The mean differential anterior laxity was 8 ± 1.9 mm before surgery and significantly decreased to 0.7 ± 0.8 mm at the last follow-up (P < .0001). Preoperatively, 41 patients had a grade 1 pivot shift, 23 had a grade 2, and 19 had a grade 3 according to the IKDC criteria. Postoperatively, 76 patients had a negative pivot shift (grade 0), and 7 patients were grade 1 (P < .0001).

Conclusion: This study demonstrates that a combined reconstruction can be an effective procedure without specific complications at a minimum follow-up of 2 years. Longer term and comparative follow-up studies are necessary to determine whether these combined reconstructions improve the results of ACL treatment.