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Degree of Anterolateral Ligament Injury Impacts Outcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction

Published:September 16, 2020DOI:https://doi.org/10.1016/j.arthro.2020.09.003

      Purpose

      To evaluate the effect of anterolateral ligament (ALL) injury identified on preoperative magnetic resonance imaging (MRI) on postoperative outcomes after double-bundle (DB) anterior cruciate ligament reconstruction (ACLR).

      Methods

      For this retrospective study, the inclusion criteria were patients who were at least 3 years out of DB ACLR. Exclusion criteria included a delay in MRI over 4 weeks, delay in surgery over 6 months, single-bundle ACLR, and revision surgery. Enrolled patients were divided into 2 groups according to the ALL injury grade in preoperative MRI by a musculoskeletal radiologist who was blinded to the perioperative findings (the high-grade group with complete or nearly complete tear: n = 53 and the low-grade group with intact ALL or partial tear: n = 33). Knee laxity, clinical outcomes using the International Knee Documentation Committee (IKDC) examination form, and revision rates were compared at the last follow-up (8.1 ± 2.2 years). An independent t test was applied to compare continuous variables, and χ
      • Ardern C.L.
      • Webster K.E.
      • Taylor N.F.
      • Feller J.A.
      Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta-analysis of the state of play.
      or Fisher exact test was used to compare the nominal variables.

      Results

      The anterior translation was 3.2 ± 1.9 mm in the high-grade group and 1.6 ± 1.0 mm in the low-grade group (P < .001). The high-grade group showed 18 cases with a pivot-shift grade of 2 or 3 (40.0%); however, the low-grade group showed only 1 case with a pivot-shift grade 2 or 3 (3.0%) (P = .002). The high-grade group also showed inferior outcomes in the IKDC objective grade (grade A: 49.0%; grade B: 17.0%; grade C: 30.2%; grade D: 3.8% vs grade A: 90.9%; grade B: 6.1%; grade C: 3.0%; grade D: 0%, P = .001) and IKDC subjective score (87.5 ± 9.9 vs 93.9 ± 5.3, P < .001). In addition, the high-grade group showed a greater revision rate (11.3% vs 0%, P = .045).

      Conclusions

      DB ACLR for patients with high-grade ALL injury resulted in increased knee laxity, worse clinical outcomes, and higher revision rate compared to patients with low-grade ALL injury.

      Level of Evidence

      Level III, retrospective comparative study
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