Summary

Combined ACL and ALL reconstruction using a flexible reaming system and adjustable loop button improves joint stability while providing patient-reported outcomes comparable to isolated ACL reconstruction.

Abstract

Background

Recent interest in anterolateral ligament (ALL) reconstruction has highlighted the need to assess its safety and effectiveness, particularly when combined with anterior cruciate ligament (ACL) reconstruction. Although various surgical techniques have been described for this combined procedure, none have emerged as superior. A promising approach involves the use of a single socket-shaped femoral tunnel and a flexible reaming system, which preserves bone stock and enhances the precision and adaptability of tunnel positioning. This technique also reduces the need for excessive knee hyperflexion during drilling and offers cost savings by eliminating the need for retrograde drills. The grafts are secured to the femur using an adjustable-loop button, which may lower the risks associated with interference screws and reduce the potential for injuries to the lateral collateral ligament.

Objective

This study aims to compare the short-term clinical outcomes of combined ACL and anterolateral ligament (ALL) reconstruction versus isolated ACL reconstruction using the same graft and femoral fixation method.

Methods

Patients undergoing combined ACL + ALL reconstruction using hamstring tendon autografts, with a single socket-shaped femoral tunnel and fixation with an adjustable-loop button facilitated by a flexible reaming system, were propensity matched 1:1 with patients undergoing isolated ACL reconstruction using the same autograft and femoral fixation method. Over 12 months, the IKDC, Lysholm, and Tegner scores, along with Pivot-shift and Lachman grades, and any complications, were recorded and compared.

Results

A total of 15 matched pairs were included. The mean age was 32 years (18-47), and 90% of the patients were male. Meniscal procedures were more frequent in the isolated ACL reconstruction group (60%). Although statistical differences were observed at 6 and 12 months in the IKDC, Tegner, and Lysholm scores, these differences were not clinically significant. Additionally, at 12 months, 2 patients with Lachman grade I and 1 patient with pivot-shift grade I were observed in the isolated ACL reconstruction group, while no such cases occurred in the combined ACL and ALL reconstruction group. During the follow-up period, there were no cases of arthrofibrosis, venous thromboembolism, infection, graft rupture, or reoperation.

Conclusion

Combined ACL and ALL reconstruction using a flexible reaming system, and an adjustable loop button yields patient-reported outcomes comparable to those of isolated ACL reconstruction in the short term. Additionally, it offers enhanced joint stability, particularly by reducing positive Lachman and pivot-shift tests.