2015 ISAKOS Biennial Congress ePoster #1250

ACL Reconstruction and the Anterolateral Ligament - Rationale, Anatomy and Early Results

Melissa Mahoney, MBBS, BSc (Hons) MRCS, London UNITED KINGDOM
Duncan Avis, MBChB, MRCS, Basingstoke UNITED KINGDOM
Sam K. Yasen, MBBS, MScEng, BSc, MRCS, FRCS(Tr&Orth), PGCE, Basingstoke, Hampshire UNITED KINGDOM
Bhushan Sabnis, FRCS, Basingstoke UNITED KINGDOM
David W. Elson, MBChB, MRCS, FRCS (T&O), Newcastle upon Tyne, Tyne & Wear UNITED KINGDOM
Michael J. Risebury, MBBS(Hons), MA(Hons), FRCS(Tr&Orth), Basingstoke, Hampshire UNITED KINGDOM
Adrian J. Wilson, FRCS, Basingstoke, Hants UNITED KINGDOM

Basingstoke and North Hampshire Hospital Trust, Basingstoke, UNITED KINGDOM

FDA Status Not Applicable

Summary: An exploration of 45 ACL and ALL reconstructions, looking at early results and outcome measures at 6 months and one year.




The importance of the anterolateral structures of the knee has been recognised for many years but the precise anatomy of the anterolateral ligament (ALL) has only been recently described. Non-anatomical extra-articular tenodesis is commonly performed to augment ACL reconstruction. We describe a surgical technique to anatomically reconstruct the ALL using the recent anatomical description by Claes et al.


An ALL reconstruction was undertaken in those demonstrating a high grade pivot shift and for all revision ACL surgery. Routinely, one set of hamstrings was used for both grafts. An anatomical all inside ACL reconstruction is performed using a quadrupled semitendinosis graftlink. The gracilis is used for the majority of ALL reconstructions. A minimally invasive ALL reconstruction is performed with 4,75mm Swivelock graft anchors.

Patients were assessed preoperatively then at 6 months and yearly intervals, recording KOOS, Lysholm and Tegner scores, range of movement and knee kinematics.


We present 45 ACL/ALL reconstructions, 38 having more than 6 months follow up (Range 6-20 months). 30 were primary reconstructions, 15 revisions. The majority used ipsilateral hamstring grafts for both ACL and ALL though in circumstances such as revisions when these were not available, either contralateral hamstrings or allograft were used.

Age range 16-62 years (33.5). Average ACL graft diameter 8.9mm, length 67.7mm.

Preoperative KOOS averaged 62.1, Lysholm 58.9, Tegner 3.5, improving to 78.3 and 82.1 and 3.5 at 6 months and 81.1, 86.2 and 4.1 at 12 months.

Range of movement maintained. All outcome measures comparable to our isolated ACL reconstructions. There were no complications.


Early results suggest no detriment to outcome with anatomical combined ACL/ALL reconstruction compared with isolated ACL reconstruction. Our technique allows anatomical reconstruction, restoring knee rotatory stability, thus minimising the risks of progressive joint disease and ACL failure.