2015 ISAKOS Biennial Congress Paper #0

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction Decreases Passive Anterior Tibial Subluxation and Provides Better Rotational Stability Compared to Isolated Anterior Cruciate Ligament Reconstruction: A Propensity Score-Matched Analysis

Hong Yeol Yang, MD, PhD, Gwangju KOREA, REPUBLIC OF
Jong-Keun Seon, MD, PhD, Prof, Gwangju, Jeonnam KOREA, REPUBLIC OF
Chonnam National University Hospital, Gwangju, Jeolanamdo, KOREA, REPUBLIC OF

FDA Status Cleared

Summary: Combined ACL and ALLR significantly reduces PATS and improves rotational stability compared to isolated ACLR, despite similar functional scales between patients in the two groups. Our findings are expected to aid clinical decision-making regarding ALLR as a treatment option in patients undergoing ACLR to improve knee stability.

Abstract:

Background

Passive anterior tibial subluxation (PATS) is encountered in patients with anterior cruciate ligament (ACL) injuries. Rotational instability of the knee following ACL reconstruction (ACLR) remains a concern post-surgery. An anatomic approach to the anterolateral ligament (ALL) has, therefore, garnered increased interest in orthopaedic sports medicine because of its potential role in knee stability.

Purpose/Hypothesis: To analyze the effect of augmenting a hamstring autograft anterior cruciate ligament reconstruction (ACLR) with an anterolateral ligament reconstruction (ALLR) on a primary outcome of passive anterior tibial subluxation (PATS) and a secondary outcome of the clinical outcomes.

Methods

ACL-injured patients who underwent primary ACLR between March 2014 and February 2020 at our center were enrolled. Patients who underwent combined procedures (ACLR + ALLR) were matched in a 1:1 propensity ratio to patients who underwent ACLR only. We evaluated PATS, knee stability (side-to-side laxity difference, pivot-shift test), and patient-reported outcome measures (PROMs) after the procedure and documented complications.

Results

From an initial cohort of 252 patients with a minimum follow-up period of two years (48.4 ± 16.6 months), 35 matched pairs were included, and 17 patients (48.6%) in each group underwent second-look arthroscopy. The combined ACLR + ALLR group showed significantly better improvement of PATS in the lateral compartments than the isolated ACLR group (P = .034). There were no significant differences between the groups regarding knee stability (side-to-side laxity difference, pivot-shift test), PROMs, complications, and second-look arthroscopic findings (all P > .05).

Conclusion

The combined ACLR + ALLR procedure was associated with a mean improvement in anterior tibial subluxation for the lateral compartment that was 1.2 mm better than an isolated ACLR procedure, despite its lack of clinical significance.