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No difference seen in incidence of ALL injury among patients with, without ACL graft ruptures
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The incidence of initial anterolateral ligament injury seen on MRI was not different in patients who had a subsequent ACL graft rupture after primary ACL reconstruction vs. patients who did not experience ACL graft rupture, according to recently published results.
Researchers used their institution's electronic medical record database to identify 1,967 patients who underwent primary ACL reconstruction with subsequent ACL graft ruptures. Patients were paired with an age-, sex, and graft-matched control who underwent ACL reconstruction without subsequent graft ruptures. On the initial MRI, patients were diagnosed with either an intact, partially injured or full ruptures of the anterolateral ligament (ALL). Investigators also noted the location of the ALL injury. The χ2 analysis was used to compare the incidence and location of ALL rupture.
Results showed there were 128 patients with an ACL graft rupture. There were 55 patients who had MRI scans available to review, of which 39 patents met the inclusion criteria and were matched with a control patient. The ALL in the revision group was diagnosed as intact in 17 patients, partially torn in 14 patients and completely torn in eight patients. However, in the control group the ALL was diagnosed as intact in 18 patients, partially torn in 13 patients and completely torn in eight patients. There was no difference seen in the frequency of ALL rupture and rupture location. – by Monica Jaramillo
Disclosures: Carr reports no relevant financial disclosures.
Perspective
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Ivan J. Antosh, LTC, MD
The ALL has garnered recent attention as a potentially important secondary stabilizer resisting the pivot shift. Recent cadaveric and biomechanical studies have demonstrated the importance of the ALL in maintaining normal knee kinematics, although the clinical necessity for ALL reconstruction in the setting of primary and revision ACL reconstruction remains unclear and a subject of debate. In their recent study, Carr and colleagues compared the incidence of ALL injury in ACL-reconstructed patients among a group of patients who experienced ACL graft rupture and a control group who did not. Interestingly, they found no difference between the groups. The biomechanical benefits of ALL reconstruction seem to be quite clear, however this study calls into question the clinical utility of ALL reconstruction in the setting of primary ACL reconstruction. Clearly, further study is warranted to better identify indications for ALL reconstruction and how this technique is best incorporated into clinical practice.
Eisenhower Army Medical Center
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