ACL plus ALL reconstruction restores normal knee stability and does not lead to lateral pain or signs of lateral overstrain

Abstract

Purpose

ACL rupture is a common injury in recreational and professional athletes. Most ACL tears occur in combination with an ALL lesion. Combined reconstruction of the ACL and ALL reduces re-rupture rates by up to 3.1 times compared to isolated ACL reconstruction using hamstring tendons; however, it has not yet been established as the surgical standard. The purpose of this study was to investigate if patients benefit from ACL+ALL reconstruction in terms of translation and rotation stability, return to activity and return to sport, as well as to assess any potential negative effects of this technique.

Methods

This is a multicentric study of retrospectively collected patients who were followed up 12.7 months postoperatively. The patient sample consisted of 55 patients (group 1: n=29, Munich/Germany, ACL+ALL, femoral ALL fixation with interference screw, and group 2: n=26, Bolzano/Italy, ACL+ALL, femoral ALL-fixation with SwiveLock). Clinical outcomes were evaluated through instrumental measurements with two different devices to assess translational anteroposterior and rotational stability and through patient-reported outcome measures (Lysholm Score, Activity Rating Scale, Tegner Score, VAS (PROMs)).

Results

A total of 55 patients (mean (± SD) age: 24.7 ± 7.8 years) with a mean follow-up of 12.7 ± 1.5 months were included. The mean anterior translation of all operated (ACL+ALL) knees was 3.2 ± 1.1 mm and was not significantly different from the values of the non-operated knees (2.6 ± 1.0 mm). The results of the anterior drawer test in internal rotation were 3.3 ± 1.1 mm for the operated knee vs. 2.7 ± 1.0 mm for the non-operated knee (p=0.0014). There were no further significant differences between the operated and non-operated knee regarding translation or internal and external rotation. The mean value for pain on the lateral side of the knee was 1.1 ± 1.3 on the VAS 0–10 pain scale. All other PROMs showed no relevant differences between pre-injury and post-operative.

Conclusion

ALL reconstruction restores the function of the anterolateral ligament of the knee. In this study, knee joint stability regarding anteroposterior translation and rotation showed values almost identical to those of the healthy non-operated contralateral knee. It leads to excellent patient outcomes with near pre-injury levels regarding the relevant PROMs. In particular, combined reconstruction did not result in any clinically significant negative side-effects such as pain on the ALL incision site or signs of overstrain in the lateral knee.

Zusammenfassung

Einleitung

Ein Kreuzbandriss ist eine häufige Verletzung bei Freizeit- und Profisportlern. Die Mehrzahl der VKB-Risse tritt in Kombination mit einer ALL-Läsion auf. Die kombinierte Rekonstruktion von VKB und ALL führt im Vergleich zur isolierten VKB-Rekonstruktion mit Hamstring-Sehnen zu einer bis zu 3,1-mal geringeren Anzahl an Rerupturen. Die OP-Technik ist dennoch noch nicht der chirurgische Standard. In dieser Studie wurde untersucht, ob Patienten von einer VKB+ALL-Rekonstruktion in Bezug auf die Rotations- und Translationsstabilität, Return to Activity und Return to Sports profitieren und ob es Nachteile in Bezug auf diese Technik gibt.

Material und Methoden

Es handelt sich um eine multizentrische Studie mit retrospektiv erfassten Patienten, die 12,7 Monate postoperativ nachuntersucht wurden. Die Studienpopulation betrug insgesamt 55 Patienten (Gruppe 1: n=29, München/Deutschland, VKB+ALL, femorale ALL-Fixation mit Interferenzschraube; Gruppe 2: n=26, Bozen/Italien, VKB+ALL, femorale ALL-Fixation mit SwiveLock). Der klinische Outcome wurde sowohl durch eine instrumentelle Messung mit 2 verschiedenen Geräten zur Beurteilung der Rotationsstabilität (Laxitester) und der Translationsstabilität (Rolimeter) als auch anhand von Patientenbefragungen (Lysholm-Score, Activity-Rating-Scale, Tegner-Score, VAS [PROMs]) bestimmt.

Ergebnisse

Insgesamt wurden 55 Patienten (mittleres [± SD] Alter: 24,7±7,8 Jahre) mit einer mittleren Nachbeobachtungszeit von 12,7±1,5 Monaten eingeschlossen. Die mittlere anteriore Translation aller operierten (ACL+ALL-)Kniegelenke betrug 3,2±1,1mm und unterschied sich nicht signifikant von den Werten der nicht operierten Kniegelenke (2,6±1,0mm). Der Lachman-Test in Innenrotation betrug 3,3±1,1mm beim operierten gegenüber 2,7±1,0mm beim nicht operierten Kniegelenk (p=0,0014). Es fanden sich keine weiteren signifikanten Unterschiede zwischen dem operierten und nicht operierten Knie bezüglich Translation oder Unterschenkelinnen- bzw. -außendrehung. Der Mittelwert für Schmerzen auf der lateralen Seite des Knies lag auf der VAS-Skala bei 1,1±1,3. Die übrigen PROMs unterschieden sich nicht signifikant vor der Verletzung zu nach der OP.

Schlussfolgerung

Die ALL-Rekonstruktion stellt die ursprüngliche Funktion des anterolateralen Ligaments des Knies wieder her. In dieser Studie erreichte die Stabilität in a.-p. Translation und Rotation nahezu identische Werte wie die nicht operierte Gegenseite. Es ergaben sich exzellente klinische Ergebnisse mit nahezu seitengleichen Werten der relevanten PROMs. Vor allem gab es keine klinisch relevanten Schmerzen an der ALL-Inzisionsstelle, und der ALL-Ersatz scheint nicht zu einer Überlastung des lateralen Knies zu führen.

Keywords

Knee - Anterior cruciate ligament - Anterolateral ligament - Rotational stability - Laxity - Reconstruction

Schlüsselwörter

Knie - Vorderes Kreuzband - Anterolaterales Ligament - Rotationsstabilität - Instabilität - Rekonstruktion

Publication History

Received: 24 October 2023

Accepted after revision: 15 December 2024

Article published online:
04 March 2025

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