When is Anterolateral Complex Augmentation Indicated? Perspectives from the 2024 Freddie Fu Panther Sports Medicine Symposium.

Abstract

Purpose: To determine the trends and indications for anterolateral complex augmentation during anterior cruciate ligament reconstruction (ACL-R) among international orthopaedic sports surgeons.

Methods: An electronically distributed survey was sent out to international surgeons with high-volume experience in complex ligament reconstructions and revision surgery attending the 2024 Freddie Fu Panther Sports Medicine Symposium. The survey was sent prior to the meeting with questions related to the use of lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALL-R) during ACL-R. Sessions pertaining to anterolateral complex augmentation were held during the symposium to inform about current clinical practices among attendees.

Results: A total of 49 surgeons were identified from 5 different geographic regions prior to the meeting date and sent an electronic survey, of which 48 responded (98% response rate). Among surgeons who reported performing anterolateral complex augmentation procedures (n=45), a total of 39 (87%) respondents reported using only the LET technique, 2 (4%) using only the ALL-R technique, and 4 (9%) using both techniques during ACL-R. The most common indication for anterolateral complex augmentation was a high-grade pivot shift, which 39/43 (91%) of respondents ranked in their top 3 indications. In the setting of primary ACL-R, respondents added a LET when using hamstring tendon autograft in 38% of cases on average compared with 34% of cases when using either bone-patellar tendon-bone autograft or quadriceps tendon autograft. In the setting of revision ACL-R, a LET was added in an average of 68% of cases for a first-time revision ACL-R and 84% of cases for a multiple revision ACL-R.

Conclusion: The most common indication for ACL-R with anterolateral complex augmentation was a high-grade pivot shift and most respondents preferred LET over ALL-R. Respondents performed LET in a comparable percentage of cases of primary ACL-R using hamstring tendon, bone-patellar tendon-bone and quadriceps tendon autografts and this number increased with the number of revision ACL-Rs. Based on the results of this survey, surgeons may consider adding a LET in cases of revision ACL-R or in patients with a high-grade pivot shift.

Level of evidence: Level V.