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Anterolateral Ligament Reconstruction is Associated with Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow Up of 2 Years

      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.