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Antero-lateral ligament reconstruction improves knee stability alongside anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Recent evidence has found the antero-lateral ligament (ALL) may play a role in stabilizing the knee, but its role in anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of the current study is to systematically review and meta-analyze the current evidence in the literature to ascertain whether ACL reconstruction combined with ALL reconstruction affects knee stability, re-rupture rates and patient-reported outcomes compared to ACL reconstructions performed alone.

Methods

A literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL + ALL reconstruction and ACL reconstruction alone were included.

Results

Six clinical trials (LOE I: I, LOE II: 2, LOE III: 3) with 729 patients were included, with a mean follow-up time of 34.2 (24–54.9) months. There was a significant difference in favor of combined ACL + ALL reconstruction for reduced re-rupture rate (2.4% vs 7.3%, p < 0.01), residual positive pivot shift rate (33.3% vs 11.4%, p < 0.01), and reduced KT-arthrometer evaluation (1.6 vs 2.6, p < 0.01). Combined ACL + ALL reconstruction resulted in improved IKDC scores (92.5 vs 87.8, p < 0.01), Lysholm scores (95.7 vs 91.2, p < 0.01) and Tegner scores (6.7 vs 5.7, p < 0.01). There was no significant difference in rate of return to play at the same level (54.3% vs 46.0%, n.s.).

Conclusion

The current evidence suggests alongside soft tissue graft ACL reconstruction that concomitant ALL reconstruction improves clinical outcomes, with improved knee stability and lower re-rupture rates.

Level of evidence

III.

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Authors and Affiliations

  1. New York University, New York, NY, USA

    Eoghan T. Hurley, Jordan W. Fried, Matthew T. Kingery, Eric J. Strauss & Michael J. Alaia

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  1. Eoghan T. Hurley
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  2. Jordan W. Fried
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  3. Matthew T. Kingery
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Correspondence to Eoghan T. Hurley.

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This manuscript is a systematic review and does not contain any studies with human participants or animals performed by any of the authors.

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Hurley, E.T., Fried, J.W., Kingery, M.T. et al. Antero-lateral ligament reconstruction improves knee stability alongside anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 764–771 (2021). https://doi.org/10.1007/s00167-020-06002-8

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  • DOI: https://doi.org/10.1007/s00167-020-06002-8

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