2025 ISAKOS Biennial Congress ePoster
The Efficacy of Isolated Anterolateral Ligament Reconstruction in Resolving Residual Rotational Instability Following ACL Reconstruction or Partial Injury: A Case Series of 18 Patients
Dong Jin Ryu, MD, PhD., Seoul KOREA, REPUBLIC OF
Yoon Sang Jeon, MD, Seoul KOREA, REPUBLIC OF
Samuel Jaeyoon Won, MD, Dongjak-Gu, Seoul KOREA, REPUBLIC OF
Inha University Hospital, Incheon, No State, KOREA, REPUBLIC OF
FDA Status Cleared
Summary
Isolated ALL reconstruction can resolve residual rotational instability following vertical positioned ACLR
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Abstract
Background
The presence of residual rotational instability can hinder optimal functional recovery post-anterior cruciate ligament (ACL) reconstruction. It can also create confusion in determining the need for surgical intervention in cases of partial ACL injuries. In recent studies, evidence has emerged suggesting that Anterolateral Ligament (ALL) reconstruction may be effective in improving rotational instability. This case series aims to evaluate the effectiveness of isolated ALL reconstruction in managing persistent rotational instability in patients who have undergone ACL reconstruction or after partial ACL injury.
Method
We evaluated a cohort of patients with documented residual rotational instability representing a pivot-shift after ACL reconstruction or partial injury of ACL. Finally, 18 patients met at least 1 of the following criteria: 1) residual rotational instability with intact ACL graft, 2) residual rotational instability after partial ACL injury with a low grade of antero-posterior (AP) instability. Exclusion criteria were 1) instability with re-injured ACL graft, 2) combined AP instability with mal-positioned previous ACL graft, and 3) partial ACL injury with a high grade of AP instability. We performed isolated ALL reconstruction using auto-gracilis graft or allograft while retaining the previous vertical positioned ACL graft or partially injured ACL. We also concurrently performed the repair of recurrent meniscus tears or previously neglected meniscus injuries. We evaluated preoperative and postoperative physical examinations including the pivot-shift test and patient-reported outcomes, and MRI exam for tibial rotation at least 1-year follow-up.
Result: Following isolated ALL reconstruction, all patients improved rotational stability. The pivot-shift test became negative in 15 out of 18 patients, indicating a resolution of rotational instability. Three patients reported still residual grade 1 pivot-shift test. However, all of the patient's subjective instability improved. The IKDC score significantly improved from an average of 62.87 ± 9.1 preoperatively to 90.62 ± 4.6 postoperatively. The Lysholm score significantly improved from an average of 66.1 ± 8.14 preoperatively to 93.2 ± 4.43 postoperatively. At 1-year follow-up MRI, all patients showed the maintenance of ALL grafts. The femur-tibial internal rotation angle (FTA) was measured on average at 8.22° (± 2.5) before and 4.26° (±1.76) 1-year after surgery. No major complications or graft failures were observed during the follow-up period.
Conclusion
Isolated ALL reconstruction could be a valuable adjunctive intervention in patients experiencing residual rotational instability after vertical-positioned ACL reconstruction or partial injury of ACL.