2017 ISAKOS Biennial Congress ePoster #1016

 

Antero-Lateral Ligament Augmentation for Persistent Rotational Instability after Anterior Cruciate Reconstruction

Jawad Sultan, MBBS, MSc, MRCS, FRCS (Tr & Orth), Bolton, Greater Manchester UNITED KINGDOM
Alison Winter, BSc, MBBS, MRCS, FRCS (Tr & Orth), Harrogate, North Yorkshire UNITED KINGDOM
David Duffy, MBBS, MRCS, FRCS, Harrogate UNITED KINGDOM
Nick London, MA, MD, FRCS (Tr & Orth), Wetherby, North Yorkshire UNITED KINGDOM

Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UNITED KINGDOM

FDA Status Cleared

Summary

For patients with persistent rotatory instability following ACL reconstruction, isolated ALL augmentation offers an alternative to full revision surgery, with shorter rehabilitation and faster return to full activity.

Abstract

Introduction

A small proportion of patients continue to have symptomatic rotatory instability following anterior cruciate ligament (ACL) reconstruction. This can be due to historical vertical graft positioning, graft stretching in the early rehab phase or even in the context of a ‘perfect’ reconstruction. Managing these patients has traditionally involved activity modification, a non-anatomic lateral tenodesis procedure or full revision ACL reconstruction. This study reports the results of isolated ALL augmentation in this cohort of patients.

Methods

Over a three-year period, 9 patients were referred with persistent instability on twisting/stepping activities following ACL reconstruction. Examination suggested an intact graft on Lachmann’s but positive pivot-shift tests. MRI revealed intact grafts although 2 were in a relatively vertical orientation, and two appeared stretched. Patients were offered isolated ALL augmentation and rapid rehabilitation, with the option of full revision if unsuccessful. ALL augmentation was performed using an artificial tape secured with absorbable anchor fixation. Tegener-Lysholm scores and time to return to sports were collected.

Results

The mean age was 29 (20 to 52) and two-thirds were males. All patients participated regularly in sports, with 5 elite/professional athletes. The mean follow-up was 15 months (3 to 30). Postoperatively, all patients felt subjectively more stable, with pivot-shift test improving by at least one grade. The mean increase in Tegner-Lysholm scores was 19.44 (14.57 to 24.32 95% CI, p<0.001). Eight of the 9 patients returned to their original pre-injury sport activity within 6 months (mean 4.14, 3.26 to 5.02 95%CI). One patient had complications from hernia surgery performed at 2 months, delaying his return to sports to 12 months.

Conclusion

For patients with persistent rotatory instability following ACL reconstruction, isolated ALL augmentation offers an alternative to full revision surgery, with shorter rehabilitation and faster return to full activity.