title: Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee With or Without Reconstruction of the Anterolateral Ligament: A Randomized Clinical Trial.
abstract: BACKGROUND
  Rotational instability of the knee remains an issue after anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to evaluate the subjective and objective outcomes of combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. The hypothesis was that favorable outcomes can be achieved with this surgical procedure compared with isolated anatomic reconstruction of the ACL.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  One hundred ten patients with a unilateral ACL injury and high-grade pivot shift were randomly assigned to undergo either combined ACL and ALL reconstruction (group A) or isolated ACL reconstruction (group B). Preoperative and postoperative evaluations of the patients were conducted by obtaining history details, recording physical examination findings, measuring knee laxity using the KT-1000 arthrometer, and using validated outcome scores for the knee. P < .05 was considered as the cut-off level of statistical significance. The Fisher exact and Mann-Whitney U tests were used to assess statistical significance.
  
  
  RESULTS
  At a mean follow-up of 27 months, 53 and 50 patients in groups A and B, respectively, were available for analysis. No statistically different outcomes were found between the 2 groups except for the KT-1000 arthrometer values. The median KT-1000 arthrometer result for combined ACL and ALL reconstruction was 1.3 mm, while the median result for isolated ACL reconstruction was 1.8 mm ( P < .001). None of the patients (n = 0; 0.0%) who underwent combined ACL and ALL reconstruction had anterior translation of greater than 5 mm at maximum pulling strength compared with their normal knees at final follow-up. On the other hand, 3 (6.0%) patients who underwent isolated ACL reconstruction had anterior translation of more than 5 mm. No serious complications were found in both groups.
  
  
  CONCLUSIONS
  Combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Nevertheless, these findings were not significantly superior to isolated ACL reconstruction except for the instrumented knee laxity testing results. This might indicate that ALL reconstruction should not be performed routinely for patients undergoing ACL reconstruction.
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Samir Abdulrazik
authors.initials: SA
authors.lastname: Ibrahim
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Emad Mureed
authors.initials: EM
authors.lastname: Shohdy
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Marwan
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Sami Abdulghaffar
authors.initials: SA
authors.lastname: Ramadan
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Abdulrahman Khalid
authors.initials: AK
authors.lastname: Almisfer
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Mohammad Wagdy
authors.initials: MW
authors.lastname: Mohammad
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Wael Shoabe
authors.initials: WS
authors.lastname: Abdulsattar
authors.affiliation: Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
authors.forename: Shiref
authors.initials: S
authors.lastname: Khirat
mesh_terms: D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
keywords: anterior cruciate ligament; anterolateral ligament; arthroscopic surgery; knee; reconstruction