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.


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


METHODS
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).


CONCLUSIONS
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.
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Générale de santé, Lyon, France sonnerycottet@aol.com.
Bertrand
B
Sonnery-Cottet
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Générale de santé, Lyon, France.
Mathieu
M
Thaunat
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Générale de santé, Lyon, France.
Benjamin
B
Freychet
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Générale de santé, Lyon, France.
Barbara H B
BH
Pupim
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Générale de santé, Lyon, France.
Colin G
CG
Murphy
Department of Orthopedic Surgery, AZ Hospital, Herentals, Belgium.
Steven
S
Claes
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D059012:Lost to Follow-Up; D065466:Lysholm Knee Score; D008297:Male; D020370:Osteoarthritis, Knee / Q000453:epidemiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055815:Young Adult
ACL reconstruction; anterolateral ligament; pivot-shift; rotational instability