Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament Injury Compared to the Isolated Reconstruction of the Anterior Cruciate Ligament: A Meta-Analysis^[*]

Abstract

The present research aims to compare the outcomes from the combined reconstruction of the anterior cruciate ligament (ACL) and of the anterolateral ligament (ALL) with the standard isolated ACL reconstruction in patients with chronic ACL injury. To do so, a meta-analysis was carried out to determine whether the combined ACL and ALL reconstruction would lead to a significant improvement in knee function according to the International Knee Documentation Committee (IKDC), the Lysholm test and KT-2000 evaluation scores and lower graft rupture rates in comparison with isolated reconstruction. To identify randomized controlled trials (RCTs) comparing the combined ACL and ALL reconstruction with the isolated ACL reconstruction, papers published between 2010 and 2019 were searched in the MEDLINE, EMBASE, SPORTDiscus, LILACS and Cochrane Central Register of Controlled Trials databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The stability of the knee joint is only marginally improved with the combined reconstruction of ACL and ALL, and both reconstruction techniques show functional results. The main outcomes sought were patient function and graft stability and rupture rates after ACL reconstruction. Out of the 421 studies identified, 6 were included in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, the studies included presented moderate-quality evidence. The graft rupture rate was higher in patients undergoing isolated ACL reconstruction (relative risk, 0.22; 95% confidence interval, 0.12 to 0.41; p < 0.00001).

Keywords

anterior cruciate ligament - anterolateral ligament - ligament injury - rupture - chronic lesion

^* Study performed at the Hospital das Forças Armadas, SQNW, 310, bloco F, apartamento 509, Brasília, DF, Brazil.

Publication History

Received: 16 September 2019

Accepted: 02 March 2020

Article published online:
02 November 2020

• Referências

• 1 Mall NA, Chalmers PN, Moric M. et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
• 2 Rezende FC. Reconstrução combinada intra e extra-articular versus reconstrução intra-articular isolada do ligamento cruzado anterior: revisão sistem [tese]. São Paulo: Universidade Federal de São Paulo (UNIFESP); 2016
• 3 Helito CP, Camargo DB, Sobrado MF. et al. Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26 (12) 3652-3659
• 4 Saithna A, Thaunat M, Delaloye JR, Ouanezar H, Fayard JM, Sonnery-Cottet B. Sonnery-CottetB. Combined ACL and anterolateral ligament reconstruction. JBJS Essential Surg Tech 2018; 8 (01) e2
• 5 Kim SJ, Choi DH, Hwang BY. The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combined with posterolateral corner reconstruction. J Bone Joint Surg Am 2012; 94 (03) 253-259
• 6 Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013; 223 (04) 321-328
• 7 Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA. The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J 2014; 96-B [phone]
• 8 Tulloch S, Getgood A. Consideration of lateral augmentation in anatomic anterior cruciate ligament reconstruction. Ann Joint 2019; 4: 15
• 9 Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 1976; 58 (02) 173-179
• 10 Cavaignac E, Faruch M, Wytrykowski K. et al. Ultrasonographic Evaluation of Anterolateral Ligament Injuries: Correlation With Magnetic Resonance Imaging and Pivot-Shift Testing. Arthroscopy 2017; 33 (07) 1384-1390
• 11 Sonnery-Cottet B, Saithna A, Cavalier M. et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI study group. Am J Sports Med 2017; 45 (07) 1547-1557
• 12 Guenther D, Rahnemai-Azar AA, Bell KM. et al. The anterolateral capsule of the knee behaves like a sheet of fibrous tissue. Am J Sports Med 2017; 45 (04) 849-855
• 13 Kittl C, El-Daou H, Athwal KK. et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med 2016; 44 (02) 345-354
• 14 Geeslin AG, Moatshe G, Chahla J. et al. Anterolateral Knee Extra-articular Stabilizers: A Robotic Study Comparing Anterolateral Ligament Reconstruction and Modified Lemaire Lateral Extra-articular Tenodesis. Am J Sports Med 2018; 46 (03) 607-616
• 15 Inderhaug E, Stephen JM, Williams A, Amis AA. Anterolateral tenodesis or anterolateral ligament complex reconstruction: effect of flexion angle at graft fixation when combined with ACL reconstruction. Am J Sports Med 2017; 45 (13) 3089-3097
• 16 Ibrahim SA, Shohdy EM, Marwan Y. et al. Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: a randomized clinical trial. Am J Sports Med 2017; 45 (07) 1558-1566