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Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Graft failure and secondary meniscal tears are major concerns after anterior cruciate ligament (ACL) reconstruction in young athletes. The aim was to evaluate the link between ACL reconstruction with and without anterolateral ligament (ALL) reconstruction and outcomes in young patients participating in pivoting sports.

Methods

This was a retrospective study of data collected prospectively. Patients less than 20 years, involved in pivoting sports and undergoing primary ACL reconstruction with a quadruple hamstring tendon (4HT) graft or 4HT graft combined with anterolateral ligament reconstruction (4HT + ALL) were included. Survival analysis was performed to identify the prognostic indicators for reoperation due to graft failure or secondary meniscal lesions. Knee laxity was assessed and patient reported outcome measures (PROMs) were collected.

Results

A total of 203 patients (mean (± SD) age: 16.3 ± 2 years) with a mean follow-up of 4.8 ± 0.9 (range: 3.3‒6.8) years were included. There were 101 4HT and 102 4HT + ALL grafts. Graft rupture rates were 11.9% for 4HT grafts and 5.8% for 4HT + ALL grafts (n.s.). There were 9.9% secondary meniscal procedures for 4HT grafts vs. 1.9% for 4HT + ALL grafts (p = 0.02). With reoperation for graft failure or secondary meniscal lesions at final follow-up as the endpoint, survival was better in the 4HT + ALL group (91.4% vs. 77.8%, respectively; p = 0.03). Absence of ALL reconstruction (HR = 4.9 [95%CI: 1.4–17.9]; p = 0.01) and preoperative side-to-side laxity > 3 mm (HR = 3.1 [95%CI: 1.03–9.1]; p = 0.04) were independently associated with an increased rate of reoperations. Mean (± SD) side-to-side laxity was 1.3 ± 1.3 mm (range: − 2 to 5) for 4HT grafts vs. 0.9 ± 1.3 mm (range: − 6 to 4.8) for 4HT + ALL grafts (n.s.) 6 months post-surgery. The rate of return to the same sport at the same level was 42.2% for 4HT grafts vs. 52% for 4HT + ALL grafts (n.s.). There was no significant difference in subjective outcomes including PROMs between the two groups.

Conclusion

Combined ALL + ACL reconstruction reduced the rate of graft failure and secondary meniscal injury in young athletes when compared to ACL reconstruction alone. Subjective results were comparable, with a similar rate of complications. Combined reconstruction should be preferred in this young population.

Level of evidence

Level IV.

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  1. Clinique du Sport de Bordeaux-Mérignac, 4 rue George Negrevergne Merignac, 33700, Bordeaux, France

    Pierre Laboudie, Adil Douiri, Nicolas Bouguennec, Alexandre Biset & Nicolas Graveleau

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Contributions

PL: design, data acquisition, statistical analysis, interpretation of data, writing and revision of the manuscript. AD: data acquisition, interpretation of data, writing and revision of the manuscript. NB: data acquisition, writing and revision of the manuscript. AB: interpretation of data, supervision, writing and revision of the manuscript. NG: design, data acquisition, statistical analysis, interpretation of data, writing and revision of the manuscript. All authors have reviewed and approve the written version of the manuscript.

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This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local Institutional Review Board (No. 12-2019-12).

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Laboudie, P., Douiri, A., Bouguennec, N. et al. Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes. Knee Surg Sports Traumatol Arthrosc 30, 3488–3498 (2022). https://doi.org/10.1007/s00167-022-06956-x

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