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Anterolateral ligament, ACL reconstruction may provide better outcomes than ACL reconstruction alone

Issue: May 2019

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Michael Donnelly

ORLANDO — Combined anterolateral ligament and ACL reconstruction may provide lower reoperation and re-rupture rates compared with ACL reconstruction alone, according to a presenter at the Arthroscopy Association of North America Annual Meeting.

In his presentation, Michael Donnelly, MB, BCH, BAO, Mch, FRCS (Tr & O), noted that residual instability following ACL reconstruction is reported in approximately 25% of patients. However, previously published research has shown significant increases in tibial translation and internal rotation with the combined sectioning of the ACL and the anterolateral ligament, according to Donnelly.

“Similarly, combined [anterolateral ligament] ALL and ACL reconstruction results in lower ACL re-rupture rates, and this has to be the goal for all of us,” Donnelly said.

He noted a systematic review showed graft re-rupture rates were 3.1-times lower and 2.5-times lower in patients who underwent combined ALL and ACL reconstruction vs. patients who received a hamstring graft or patellar tendon graft, respectively.

“Combined ACL and ALL reconstruction is also, or has been shown to be, meniscal protective,” Donnelly said, with previously published research showing failure of medial meniscal repair was two-times lower among patients who underwent combined ALL and ACL reconstruction.

Another study showed the importance of ALL reconstruction in the revision ACL setting, he said.

“They showed lower rates of pivot shift-positive patients postop in the combined group and, more important than that as we all know is, that the return to sport at same level was statistically higher again in the combined group,” Donnelly said. – by Casey Tingle

Reference:

Donnelly M. Donnybrook: ALL is needed for “perfect” ACL. Presented at: Arthroscopy Association of North America Annual Meeting; May 2-4, 2019; Orlando.

Disclosure: Donnelly reports no relevant financial disclosures.