An interventional study on functional outcome of combined anterior cruciate ligament and anterolateral ligament reconstruction
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193839Keywords:
Anterior cruciate ligament, Anterolateral ligament, Knee instability, Pivot shift, Sports injuryAbstract
Background: The anterolateral ligament (ALL) is an important structure for rotational stability of knee joint after anterior cruciate ligament (ACL) rupture. Outcome of combined ACL and ALL reconstruction will change view of high demanding ACL tear cases.
Methods: A hospital based prospective interventional study was done in Department of Orthopaedics, SMS Medical College, Jaipur to find the functional outcome of combined anterior cruciate ligament and anterolateral ligament reconstruction. A total of 45 patients underwent ACL and ALL reconstruction. Indications for a combined procedure were associated grade 3 pivot shifts, high level of sporting activity and pivoting sports. Patients were assessed pre- and post-operatively with objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale.
Results: The mean follow up time was around 5 months. Two patients lost to follow up. Leaving 45 patients for final evaluation. At the last follow-up, all patients had full range of motion. The Lysholm, subjective IKDC, and objective IKDC scores were significantly improved (all p<0.0001). Pre-operatively, 38 patients had a grade 3 pivot shifts and 7 had a grade 2 according to the IKDC criteria. Post-operatively, 42 patients had a negative pivot shift (grade 0), and 3 patients were grade 1 (p<0.0001).
Conclusions: This study demonstrates that a combined reconstruction can be an effective procedure without specific complications at a minimum follow-up of 6 months. Longer follow up is required to know any long term complications and functional outcome.
References
Amis AA, Bull AM, Lie DT. Biomechanics of rotational instability and anatomic anterior cruciate ligament reconstruction. Oper Techn Orthop. 2005;15:29-35.
Amis AA, Scammell BE. Biomechanics of intra-articular and extraarticular reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 1993;75(5):812-7.
Anderson AF, Snyder RB, Lipscomb AB. Anterior cruciate ligament reconstruction: a prospective randomized study of three surgical methods. Am J Sports Med. 2001;29(3):272-9.
Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3186-95.
Chambat P, Vargas R, Fayard JM, Lemaire B, Sonnery-Cottet B. Résultat des reconstructions du ligament croisé antérieur sous contrôle arthroscopique avec un recul supérieur à 15 ans. In: Chambat P, Neyret P (éd). Le genou et le sport du ligament à la prothèse. France: Sauramps Médical; 2008: 147-152.
Chambat P, Guier C, Sonnery- Cottet B, Fayand JM, Thaunat M. The evolution of ACL reconstruction over the last fifty years. Int Orthop. 2013;37:181-6.
Chouliaras V, Ristanis S, Moraiti C, Stergiou N, Georgoulis AD. Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone- patellar tendon –bone autografts: an in vivo study comparing tibial internal- external rotation. Am J Sports Med. 2007;35:189-96.
Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT, et al. The influence of hamstring auto graft size on patient- reported outcome and risk of revision after anterior cruciate ligament reconstruction: A Multicenter Orthopaedic outcomes network (MOON) cohort study. Arthroscopy. 2013;29(12):1948-53.
van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH. Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med. 2012;40:800-7.
Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:641-7.
