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ANTEROLATERAL LIGAMENT OF THE KNEE
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CLINICAL OUTCOMES
The “rediscovery” of the ALL has redirected
the attention of orthopaedic surgeons to
peripheral knee structures that contribute to
rotational instability. Published studies have
shown that lateral tenodesis associated with
ACL reconstruction can reduce rotational
instability, but that it does not necessarily
have a significant effect on clinical outcomes.
Only one article has reported clinical
outcomes
after
combined
ALL/ACL
reconstruction [21]. In 2015, Sonnery-Cottet
and
colleagues
described
92 ACL
reconstruction cases performed concurrently
with percutaneous ALL reconstruction. The
semitendinosus tendon was used for the ACL.
A double-bundle gracilis tendon was used for
the percutaneous ALL reconstruction to
reproduce its triangular shape with large tibial
attachment. The mean follow-up was
32.4 months (24-39). Pre-operatively,
47 patients had a grade 1 pivot shift, 22 had
grade 2 and 23 had grade 3. After the surgery,
82 patients had no pivot shift and 10 had a
grade 1 pivot shift. There were no specific
complications related to the surgical
technique. One patient had an ACL rerupture
1 year after the surgery, while six patients had
a contralateral ACL tear. These findings were
confirmed in a retrospective study of more
than 600 ACL-deficient patients operated
between 2011 and 2014 who were reviewed
after 40 months. The rerupture rate was
significantly lower in the group with combined
ACL/ALL reconstruction than in the group
with isolated ACL reconstruction (patellar
tendon or hamstring graft).
The excellent stability and functional outcome,
the simplicity of the surgical technique, the
small aesthetic impact of the percutaneous
technique and the low failure rate have allowed
us to expand our indications considerably over
the past 5 years. Combined reconstruction is
now performed in nearly 50% of our ACL
reconstruction patients. We strongly believe
that this combined technique not only provides
better control over rotational stability, but also
reduces the rerupture rate in high-risk patients
(e.g. under 20 years of age, competitive
athletes, pivot sports, lateral notch, etc.).
CONCLUSION
In our hands, combined ACL/ALL re
construction performed in more than
1000 patients has led to good clinical outcomes
with no specific complications related to the
ALL reconstruction. Along with satisfactory
rotational control, the significantly lower
rerupture rate versus isolated reconstruction
techniques (BPTB, HG) has lead us to expand
our indications. A prospective randomised
study has been initiated to address the absence
of a control group and the need for longer
follow-up.