2017 ISAKOS Biennial Congress ePoster #1171

 

Combined Reconstruction Of Anterolateral Ligament And Anterior Cruciate Ligament: Technique And Early Result

Zimin Wang, PhD, Shanghai CHINA
Xuan Huang, MD, PhD, Shanghai CHINA
Zhe Lu, MD, Shanghai, Shanghai CHINA
Yi Wang, MD, Shanghai CHINA
Lei Xiao, MD, Shanghai CHINA
Quan Li, MD, Shanghai CHINA
Ce Zhan, MD, Shanghai, Shanghai CHINA

changhai hospital, shanghai, shanghai, CHINA

FDA Status Cleared

Summary

This study demonstrated that a combined ALL and ACL reconstruction using hamstring autograft successfully controls the rotatory instability of the ACL injured knee in the majority of cases without specific complications.

Abstract

Methods: 38 pts were recruited in CR group. In the surgery, two strands of hamstring autograft (ST & GT), usually longer than 24 cm, were folded at its point of 1/3 for weaving. The graft was designed as one half with 4 strands for ACL and another half with 2 strands for ALL. In case of the diameter for ACL graft is less than 7 mm, we use AHPLA combined with HA as graft. After weaving, the whole graft would be longer than 16cm. A single femoral tunnel was drilled with outside-in technique to address both the ACL and ALL insertion points on femur. The location of ALL position was defined as 5mm proximal and 5mm posterior from the lateral epicondyle. The tibial insertion of the ALL was taken to be roughly 1/4 between the Gerdy tubercle and the fibular head. The graft was secured with interference screw in femoral tunnel and in two tibial tunnels. 42 pts were recruited in AR group. In this group, single bundle anatomic ACL reconstruction was performed. Only HA was used as graft. We use Endo-button for femural fixation and interference screw for tibial fixation.

Results

36 pts from CR group and 35 pts from AR group were followed at an average of 12 ± 4months. There were no significant differences in the postoperative range of motion, visual analog scale score, Lysholm score, and International Knee Documentation Committee knee evaluation form score between the 2 groups (P > .05). The pivot-shift test was significantly better in the CR group than the AR group (P =.037). However, there were no significant differences in the Lachman test, anterior drawer test and KT-1000 arthrometer test between the 2 groups (P .05). Discussion: In 2013, Dr Claes published his anatomic study describing the anatomy and function of ALL. In his study, the ALL was found as a well-defined ligamentous structure in 97% cadaver knees. But in our study, we found ALL in only 4 of 10 cadaver knees. Nevertheless, lateral extra-articular procedures similar to ALL reconstruction were popular in ninety seventies and eighties, but fell from favor due to lack of addressing the torn ACL and poor result. Recently, persistent problems with rotational control in modern ACL reconstructive techniques have lead to a resurgence of interest in the concept of lateral reinforcement. These techniques have a biomechanical advantage over intra-articular reconstruction in terms of rotational control. We believed that in case of grade 3 pivot shift test, both ACL and anterolateral capsule structure have severe injury. So the reconstruction procedure should address both pathologies. And our technique using only one graft and making one tunnel in femur simplified the procedure. In our technique, the location of ALL more proximal on femoral side and more anterior on tibia side as compared to its anatomic insertion. We believe the orientation of the ALL graft could provide better control of antero-posterior stability in 90 degree of knee flexion and better control of internal rotation in flexion and extension of the knee.