Abstract
Background
To compare the clinical outcomes between isolated cruciate ligament reconstruction (ACLR) and combined ACL with anterolateral ligament reconstruction in chronic ACL injury especially with rotary instability problem.
Methods
Systematic searches were conducted of literature published up to July 2021 on PubMed, Google Search, and Cochrane databases for studies comparing isolated ACLR and ACL with anterolateral reconstruction. Two reviewers independently determined eligibility, extracted outcome data, and assessed the risk of bias of eligible studies. Pooled clinical outcomes used random effects with mean differences and risk ratio for continuous and dichotomous variables, respectively.
Results
After excluding 49 articles based on full-text screening, six studies were identified which met the inclusion criteria in the meta-analysis. Clinical outcomes such as residual laxity, rotatory instability, and graft failure were compared between isolated ACLR and combined ACL and anterolateral stability reconstruction. Overall, both clinical outcomes of isolated ACL and combined ACL with anterolateral reconstruction show improvement results in pivot shift test, the absence of residual laxity and incidence of graft failure. Compared to isolated ACLR, the prominent postoperative result was by combined ACL with anterolateral reconstruction which had significant differences in laxity outcome based on (I2 = 89%, p < 0.00001) and (MD = 0.71, 95%CI: 0.33–1.08, p = 0.00002).
Conclusions
The combined ACL with anterolateral reconstruction tended to have superior clinical outcomes, especially in the absence of residual laxity, compared to the isolated ACLR, but the other results were not significantly different statistically. Combined ACL and anterolateral reconstruction were not performed routinely for patients undergoing ACL reconstruction, but more suitable for chronic rotatory instability problem.
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References
Erden T, Toker B, Toprak A, Taşer O (2021) Comparison of the outcomes of isolated anterior cruciate ligament reconstruction and combined anterolateral ligament suture tape augmentation and anterior cruciate ligament reconstruction. Jt Dis Relat Surg 32(1):129–136. https://doi.org/10.5606/ehc.2020.78201
Ibrahim SA et al (2017) Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament. Am J Sports Med 45(7):1558–1566. https://doi.org/10.1177/0363546517691517
Brown C. Anatomic ACL reconstruction. Sport Medical Journal ASPETAR. https://www.aspetar.com/journal/upload/PDF/201418125811.pdf
Hamido F et al (2020) Anterolateral ligament reconstruction improves the clinical and functional outcomes of anterior cruciate ligament reconstruction in athletes. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06119-w
Sonnery-Cottet et al (2020) Combined ACL and anterolateral reconstruction is not associated with a higher risk of adverse outcomes. Orthopaedic J Sports Med 8(5):2325967120918490. https://doi.org/10.1177/2325967120918490
Helito CP et al (2019) Combined reconstruction of the anterolateral ligament in patients with ACL injury and ligamentous hyperlaxity leads to better clinical stability and a lower failure rate than isolated ACL reconstruction. J Arthroscopic Related Surg. https://doi.org/10.1016/j.arthro.2019.03.059
Helito CP et al (2018) Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-4934-2
Nitri M (2016) An in vitro robotic assessment of the anterolateral ligament: part 2, anterolateral ligament reconstruction combined with anterior cruciate ligament reconstruction. Am J Sports Med 44(3):593–601. https://doi.org/10.1177/0363546515620183
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097pmid:19621072
Tulloch S, Getgood A (2019) Consideration of lateral augmentation in anatomic anterior cruciate ligament reconstruction. Ann Joint. https://doi.org/10.21037/aoj.2019.02.01
Fu et al (2020) Is all inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? BMC Musculoskeletal Disorders, A systematic review and meta-analysis Fu et al. https://doi.org/10.1186/s12891-020-03471-3
Kelly et al (2021) Biomechanical effects of combined anterior cruciate ligament reconstruction and anterolateral ligament reconstruction: a systematic review and meta-analysis. Orthopaedic J Sports Med 9(6):23259671211009880. https://doi.org/10.1177/23259671211009879
Ferretti A et al (2016) Combined intra-articular and extra-articular reconstruction in anterior cruciate ligament deficient knee: 25 years later. Arthroscopy J Arthroscopic Related Surg. https://doi.org/10.1016/j.arthro.2016.02.006
Rosenstiel N et al (2018) Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years. Arthroscopy J Arthroscopic Related Surg. https://doi.org/10.1016/j.arthro.2018.09.020
Gurpinar T (2019). Decision-Making for ALL Reconstruction and Surgical Techniques. https://doi.org/10.5772/intechopen.86398
Delaloye JR et al (2017) Clinical outcomes after combined anterior cruciate ligament and anterolateral ligament reconstruction. Techniques Orthopaedics 33(4):225–231. https://doi.org/10.1097/bto.00326
Delaloye JR et al (2018) Combined anterior cruciate ligament and anterolateral ligament lesions: from anatomy to clinical results. Ann Joint 3:82. https://doi.org/10.21037/aoj.2018.09.08
Daggett M et al (2021) Clinical results of combined ACL and anterolateral ligament reconstruction: a narrative review from the SANTI Study Group. J Knee Surg 34(09):962–970. https://doi.org/10.1055/s-0040-1701220
Cheng et al (2020) Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis. BMC Musculoskelet Disord 21:414. https://doi.org/10.1186/s12891-020-03438-4
Jankovic et al (2021) Modified technique for combined reconstruction of anterior cruciate ligament and anterolateral ligament. Arthrosc Tech. https://doi.org/10.1016/j.eats.2020.10.046
Gomes JLE et al (2017) Intra-articular Anterior Cruciate Ligament Reconstruction with Extra-articular Lateral Tenodesis of the Iliotibial Band. Arthrosc Tech. https://doi.org/10.1016/j.eats.2017.05.032
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Rhatomy, S., Ariyanto, M.W., Fiolin, J. et al. Comparison of clinical outcomes between isolated ACL reconstruction and combined ACL with anterolateral ligament reconstruction: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33, 685–694 (2023). https://doi.org/10.1007/s00590-021-03194-8
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DOI: https://doi.org/10.1007/s00590-021-03194-8