2025 ISAKOS Biennial Congress Paper
ACL + ALL Outperforms Isolated ACL Reconstruction: 5-Year Outcomes From A SANTI Study Group Randomized Clinical Trial
Bertrand Sonnery-Cottet, MD, PhD, Lyon, Rhône FRANCE
Alessandro Carrozzo, MD, Rome ITALY
Jean-Marie Fayard, MD, Lyon, Rhône FRANCE
Benjamin Freychet, MD, Lyon FRANCE
Thais Dutra Vieira, MD, Lyon, Rhone FRANCE
Mathieu Thaunat, MD, Lyon, Auvergne Rhône Alpes FRANCE
Adnan Saithna, MD, FRCS, Scottsdale, AZ UNITED STATES
Centre Orthopedique Santy, Lyon, FRANCE
FDA Status Not Applicable
Summary
Combined ACL and ALL reconstruction with hamstring tendons significantly outperforms isolated ACL reconstruction with a "gold standard" BTB graft, with respect to overall re-operation rates.
Abstract
Purpose
To compare the clinical outcomes of combined ACL and anterolateral ligament (ALL) reconstruction against isolated ACL reconstruction in a prospective randomized clinical trial (RCT). The hypothesis was that combined reconstructions would confer a lower graft failure rate, and lower overall re-operation rate than following isolated ACL reconstruction.
Methods
A prospective RCT was conducted. Isolated ACL reconstruction using a "gold standard" BTB graft was compared against combined ACL and ALL reconstruction using hamstring tendons (HT + ALLR). Participants were randomized in a 1:1 ratio. Clinical outcomes were assessed regularly, up to a minimum 5 years. The primary outcome measure was the graft rupture rate. Reoperations, contralateral ACL rupture rates, PROMS and knee laxity parameters were also recorded.
Results
592 patients with a mean follow-up of 61.2 months were included. Loss to follow up was 6.1%. Contralateral injury rates were not significantly different between groups (9,5%). 42 patients experienced ipsilateral graft failure (7.6%), with 12 (4.2%) in the HT + ALLR group and 30 (11%) in the isolated BTB group (p=0.0026). The risk of graft failure was 2.83-fold higher in the BTB group compared to the HT + ALL group ((OR 2.83; 95% CI: 1.43-5.95, p = 0.0025). Overall re-operations were 3.67 times higher in the BTB group (OR 3.67; 95% CI: 2.18-6.42, p < 0.0001). This also included cyclops syndrome (7.4% vs 1%, p=0.0002) and secondary meniscectomy (5.9% vs 2.1%, p=0.0197). There were no significant differences with respect to PROMS, RTS and knee laxity.
Conclusion
Combined ACL and ALL reconstruction with hamstring tendons significantly outperforms isolated ACL reconstruction with a "gold standard" BTB graft, with respect to overall re-operation rates. These findings are due to higher rates of graft failure, cyclops syndrome and secondary meniscectomy in the BTB group.