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Combined Anatomic Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction
Purpose: The purpose of the current paper was to report the surgical technique of combined anatomic anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction as well as the short term clinical results after this surgical procedure.
Material and Methods: The current prospective study included 32 patients (5 females and 27 males) with combined ACL and ALL reconstruction performed between December 2015 and July 2016. The patients were included in the study taking into consideration the following criteria: chronic ACL lesion, high grade rotational instability (pivot shift grade II and III) and participation in high grade pivoting sports. Patient evaluation followed an established clinical and imaging protocol both preoperatively and at 6 and 12 weeks postoperatively. This included clinical knee stability testing (Lachman test, Pivot shift test), Rolimeter differential laxity testing, subjective and objective IKDC scores and Lysholm score and Tegner score.
Results: Postoperative stability at 6 weeks and 12 weeks as tested with Lachman test (p=0.02 and 0.01, respectively), pivot shift test (p=0.03 and 0.01, respectively) and the Rolimeter arthrometer (p=0.008 and 0.006, respectively) showed a statistically significant difference as compared to preoperative values. Postoperative scores at 6 weeks and 12 weeks as measured using objective IKDC form (p=0.008 and 0.006, respectively), subjective IKDC form (p=0.04 and 0.03, respectively) and Lysholm form (p=0.02 and 0.01, respectively) were statistically significant improved as compared to preoperative values. All patients had a negative Lachman test at 6 and 12 weeks postoperatively. One patient had a positive grade I pivot shift test at 6 weeks postoperatively and two patients had a positive grade I pivot shift test at 12 weeks postoperatively. Differential anteroposterior laxity as measured with the Rolimeter arthrometer improved from 7.19±1.96 mm preoperatively to 0.28±0.45 mm and 0.13±0.34 mm, at 6 weeks and 12 weeks postoperatively, respectively. According to the objective IKDC form, 29 patients were normal or nearly normal (grade A and B) at 6 weeks postoperatively and 31 patients were normal or nearly normal at 12 weeks postoperatively. Subjective IKDC score improved from 47.72±17.18 preoperatively to 56.52±11.74 and 73.38±14.28 at 6 and 12 weeks postoperatively, respectively. Lysholm score improved from 63.44±23.01 preoperatively to 80.41±11.94 and 90.47±8.22 at 6 and 12 weeks postoperatively, respectively. Improved Tegner activity scores were present at 12 weeks postoperatively as compared with 6 weeks postoperatively, but still lower as compared to pre-traumatic scores. No significant complications were present in the current study group.
Conclusions: Combined ACL and ALL reconstruction is an effective surgical procedure, with improved postoperative clinical results and no significant short term complications. Longer follow-up is necessary in order to better evaluate the results of this procedure.
Keywords: anterior cruciate ligament, antero lateral ligament, anatomic reconstruction