Introduction
To evaluate the role of combined ACL and Anterolateral Ligament (ALL) reconstruction in reducing graft rupture rates and improving return to sport in a high-risk population of young patients participating in contact sports.
Methods
A prospective series of 502 patients undergoing primary ACL reconstruction with either bone-patellar tendon-bone (BPTB n=105), quadrupled hamstring tendons (4HT n=176), or combined hamstring tendon and ALL reconstruction (HT+ALL n=221) was studied. Kaplan Meier analysis and multivariate Cox regression models were used to identify prognosticators of outcome.
Results
The mean age was 22.4 ± 4.0 years (range 16-30). The mean duration of follow-up was 38.4 months (range 24-54). The mean post-operative subjective IKDC score was 84.4 +/- 11.6. There was no difference between groups with respect to the postoperative improvement in IKDC or the mean side-to-side laxity difference 0.5 +/-0.9mm. The rate of ACL graft failure in patients with HT+ALL grafts was 3.1 times less than with 4HT [hazard ratio, 0.327; 95% CI 0.13-0.758] and 2.5 times less than with B-PT-B [hazard ratio, 0.393; 95% CI 0.153-0.953]. There was no significant difference in the graft failure rate between 4HT and B-PT-B [hazard ratio, 1.204; 95% CI 0.555-2.66]. Overall, 93% of patients returned to sport at latest follow-up. Return to pre-injury level of sport was 64.6%. HT+ALL grafts were associated with higher odds of return to pre-injury level of sport than 4HT [Odds ratio, 1.938; 95% CI 1.174-3.224].
Conclusion
This study is the first to demonstrate that the rate of ACL graft failure with HT+ALL is significantly less than with ACL reconstruction performed with B-PT-B or 4HT only. HT+ALL is also associated with significantly greater odds of returning to the pre-injury level of sport when compared to 4HT. Clinical results at latest follow up show no evidence of increased complications or overconstraint compared to other common techniques of ACL reconstruction.
Article info
Publication history
SS-11May 18, 2017, 11:45 AM
Identification
Copyright
© 2017 Published by Elsevier Inc.
