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J Knee Surg 2021; 34(09): 962-970
DOI: 10.1055/s-0040-1701220
Original Article

Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group

Adnan Saithna 
1   Kansas City University of Medicine and Biosciences, Kansas City, Missouri
2   Sano Orthopedics, Overland Park, Kansas
3   School of Science and Technology, Nottingham Trent University, Clifton Campus, Nottingham, United Kingdom
,
Matt Daggett
1   Kansas City University of Medicine and Biosciences, Kansas City, Missouri
2   Sano Orthopedics, Overland Park, Kansas
,
Camilo Partezani Helito
4   Department of Orthopedic Surgery, Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
5   Department of Orthopedic Surgery, Hospital Sírio Libanês, São Paulo, Brazil
,
Edoardo Monaco
6   Department of Orthopedic Surgery, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
,
Florent Franck
7   Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France
,
Thais Dutra Vieira 
7   Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France
8   Department of Orthopedic Surgery, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
,
Charles Pioger
7   Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France
,
Jin Goo Kim
9   Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, South Korea
,
Bertrand Sonnery-Cottet
7   Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France
8   Department of Orthopedic Surgery, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
› Author Affiliations Funding None.
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Abstract

Lateral extraarticular procedures (LEAPs) in the anterior cruciate ligament (ACL)-injured knee were widely abandoned in the 1990s but have seen a recent resurgence. The aim of this review was to demonstrate that anterolateral ligament reconstruction (ALLR) is associated with evidence of significant advantages and no evidence of historical concerns. A narrative review of the literature was performed. Combined ACL + ALLR is associated with improved outcomes when compared against isolated ACL reconstruction, including a significantly lower risk of ACL graft rupture (hazard ratio [HR]: 0.327, 95% CI: 0.130–0.758), a significantly lower risk of reoperation for secondary meniscectomy following medial meniscal repair at the time of ACL reconstruction (HR: 0.443, 95% CI: 0.218–0.866), significantly increased likelihood of return to the preinjury level of sport following primary (odds ratio [OR]: 1.938, 95% CI: 1.174–3.224) and revision ACL reconstruction (57.1 vs. 25.6%, respectively; p = 0.008), and in chronic ACL injuries, less residual pivot shift (9.1 vs. 35.3%, p = 0.011), and better IKDC (92.7 ± 5.9 vs. 87.1 ± 9.0, p = 0.0013) and Lysholm (95.4 ± 5.3 vs. 90.0 ± 7.1, p < 0.0001) scores, and no evidence of historical concerns. Combined ACLR + ALLR is associated with excellent clinical outcomes with no evidence of the adverse events that led to the historical widespread abandonment of other types of LEAP. Specifically, comparative series have demonstrated significant advantages of ALLR when compared against isolated ACLR with respect to reduced rates of ACL graft rupture, secondary meniscectomy, persistent instability, and significantly improved functional outcomes and improved return to sport metrics.

Keywords

anterior cruciate ligament reconstruction - anterolateral ligament reconstruction - lateral extraarticular procedures


Publication History

Received: 09 September 2019

Accepted: 27 November 2019

Article published online:
05 February 2020

© 2020. Thieme. All rights reserved.

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