Summary: Patients who undergo combined ACL and anterolateral ligament reconstruction experience significantly better long-term ACL graft survivorship, a five-fold lower risk of graft rupture, lower overall rates of re-operation, and no increase in complications when compared to those who undergo isolated ACL reconstruction

Introduction

Recent clinical studies have demonstrated significant advantages of combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALLR) over isolated ACL reconstruction (ACLR) with respect to reduced graft rupture rates, a lower risk of re-operation for secondary meniscectomy, improved knee stability, and higher rates of return to pre-injury levels of sport. However, due to the relative infancy of this procedure, long term studies have not yet been published, and it remains to be seen whether the reported advantages of the combined procedure are maintained at long term follow-up.

The primary objective of this study was to compare the long-term clinical outcomes of isolated ACLR versus combined ACL+ALLR. The hypothesis was that patients who underwent combined procedures would experience significantly lower ACL graft rupture rates at long term follow-up than their matched counterparts who underwent isolated ACLR.

Methods

Patients undergoing primary ACL+ALLR between January 2011 and March 2012 were propensity matched in a 1:1 ratio to patients who had undergone isolated ACL reconstruction during the same period. Face-to-face post-operative follow-up was undertaken at 3 and 6 weeks, and 3, 6, 12 and 24 months. Due to the geographically mobile nature of young populations (particularly notable at long-term follow up), and the impact of COVID-19, the final follow up was conducted using a standardized telemedicine interview (between April and May 2020), completion of PROMs questionnaires and review of medical notes. The telemedicine interview and notes review sought to determine whether patients had sustained a further ipsilateral knee injury, had experienced any symptoms of knee instability or stiffness, or had undergone any re-operations or complications. As a result of these follow-up arrangements, physical examination findings (range of motion and knee stability) are reported at two-years follow up. Complications, re-operations and outcome measures including Lysholm, Tegner, IKDC and KOOS are reported at the final follow-up. Graft survivorship was assessed using Kaplan-Meier analysis. Logistic regression was performed in order to account for the potential impact of activity level on graft rupture rates.

Results

86 matched pairs were included in the study. The mean duration of follow-up was 104.33±3.84 months (range 97-111 months). Patients who underwent combined ACL+ALLR experienced significantly better ACL graft survivorship (96.5% vs 82.6%, p=0.0027), lower overall rates of re-operation (15.3% vs 32.6%, p<0.05), lower rates of revision ACLR (3.5% vs 17.4%, p<0.05), and no increase in complications, when compared to those who underwent isolated ACLR. Patients undergoing isolated ACLR were at more than five-fold greater risk of graft rupture (OR, 5.549; 95%CI 1.431 to 21.511, p = 0.0132), regardless of their pre-injury activity level.

Conclusion

Patients who undergo combined ACL and anterolateral ligament reconstruction experience significantly better long-term ACL graft survivorship, lower overall rates of re-operation, and no increase in complications when compared to those who undergo isolated ACLR. In contrast, patients undergoing isolated ACLR had a greater than five-fold increased risk of undergoing revision surgery at a mean follow-up of 104.3 months.

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Early Return To Sport After Quadriceps Tendon Autograft ACL Reconstruction: Comparison To Bone-Patellar Tendon-Bone Autograft At A Minimum 1-Year Follow-Up ePoster Presentation Evan W. James, MD, UNITED STATES Dakota Adamec , BS , UNITED STATES Spencer Sullivan, BS, UNITED STATES Per-Henrik Randsborg, MD, PhD, NORWAY Brandon Schneider, MS, UNITED STATES Robert G. Marx, MD, UNITED STATES Answorth A. Allen, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Benedict U. Nwachukwu, MD, MBA, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Edoardo Monaco, MD, ITALY Edoardo Gaj, MD, ITALY Valerio Andreozzi, ITALY Alessandro Annibaldi, MD, ITALY Alessandro Carrozzo, MD, ITALY Thais Dutra Vieira, MD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE Andrea Ferretti, Prof., ITALY
Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Higher Return To Pre-Injury Activity Levels Following ACL Reconstruction With Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft In High Activity Patients: Results From The New Zealand ACL Registry Abstract Presentation 6 minutes Simon W. Young, MD, FRACS, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Mark G. Clatworthy, FRACS, NEW ZEALAND Paul Monk, DPhil (Oxon), FRCS, NEW ZEALAND Hamish Love, FRACS, NEW ZEALAND
Comparative Study Of “Concomitant Patellar Tendon Rupture With Anterior cruciate ligament tear and Patellar Tendon Rupture With Multi- Ligamentous Knee Injury –MLKI” Abstract Presentation 6 minutes Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Rajagopalakrishnan Ramakanth, D.ortho, DNB(ortho), D.SICOT, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
THE OUTCOME OF BALANCE EXERCISES AND AGILITY TRAINING FOR POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: CLINICAL ASSESSMENT Abstract Presentation 7 minutes SITI MAIZATUL AKMAL ISMAIL, Medical Science (Orthopaedic Surgery Sports), MALAYSIA
Why, When and Who Fails Non-Operative Treatment of Anterior Cruciate Ligament Injury – An Exploratory Analysis of the COMPARE Trial Abstract Presentation 5 minutes Sabine van der Graaff, MD, NETHERLANDS Duncan E. Meuffels, MD, PhD, Prof., NETHERLANDS Sita Bierma-Zeinstra, MD, NETHERLANDS Eline van Es, MSc, NETHERLANDS Jan Verhaar, MD, PhD, Prof., NETHERLANDS Vincent Eggerding, MD, NETHERLANDS Max Reijman, PhD, NETHERLANDS

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Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis

Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis

Introduction

Methods

Results

Conclusion

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Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis

Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis

Introduction

Methods

Results

Conclusion

More ISAKOS 2021: Global Content