ACL plus ALL reconstruction restores normal knee stability and does not lead to lateral pain or signs of lateral overstrain.

Abstract

ACL rupture is a common injury in recreational and professional athletes. Most ACL tears occur in combination with an ALL lesion. Combined reconstruction of the ACL and ALL reduces re-rupture rates by up to 3.1 times compared to isolated ACL reconstruction using hamstring tendons; however, it has not yet been established as the surgical standard. The purpose of this study was to investigate if patients benefit from ACL+ALL reconstruction in terms of translation and rotation stability, return to activity and return to sport, as well as to assess any potential negative effects of this technique.This is a multicentric study of retrospectively collected patients who were followed up 12.7 months postoperatively. The patient sample consisted of 55 patients (group 1: n=29, Munich/Germany, ACL+ALL, femoral ALL fixation with interference screw, and group 2: n=26, Bolzano/Italy, ACL+ALL, femoral ALL-fixation with SwiveLock). Clinical outcomes were evaluated through instrumental measurements with two different devices to assess translational anteroposterior and rotational stability and through patient-reported outcome measures (Lysholm Score, Activity Rating Scale, Tegner Score, VAS (PROMs)).A total of 55 patients (mean (± SD) age: 24.7 ± 7.8 years) with a mean follow-up of 12.7 ± 1.5 months were included. The mean anterior translation of all operated (ACL+ALL) knees was 3.2 ± 1.1 mm and was not significantly different from the values of the non-operated knees (2.6 ± 1.0 mm). The results of the anterior drawer test in internal rotation were 3.3 ± 1.1 mm for the operated knee vs. 2.7 ± 1.0 mm for the non-operated knee (p=0.0014). There were no further significant differences between the operated and non-operated knee regarding translation or internal and external rotation. The mean value for pain on the lateral side of the knee was 1.1 ± 1.3 on the VAS 0-10 pain scale. All other PROMs showed no relevant differences between pre-injury and post-operative.ALL reconstruction restores the function of the anterolateral ligament of the knee. In this study, knee joint stability regarding anteroposterior translation and rotation showed values almost identical to those of the healthy non-operated contralateral knee. It leads to excellent patient outcomes with near pre-injury levels regarding the relevant PROMs. In particular, combined reconstruction did not result in any clinically significant negative side-effects such as pain on the ALL incision site or signs of overstrain in the lateral knee.