Combined Anterior Cruciate Ligament Reconstruction and Anterior-lateral ligament reconstruction

INTRODUCTION: It is common to observe residual pivot shift in patients receiving anterior cruciate ligament reconstruction (ACLR) despite successful control of anterior-posterior laxity. It is believed that failure to reconstruct anterior-lateral ligament (ALL) is a possible reason. However, it is not known whether combined ACLR and ALLR will produce superior results when compared with isolated ACLR alone. METHODOLOGY: To answer this question, a prospective case-control study comparing (i) combined ACLR and ALLR (ACLR-ALLR), (ii) double bundle ACLR (DBACLR) and (iii) single bundle ACLR (SBACLR) was conducted. 85 patients receiving ACLR using hamstring autograft were followed up prospectively. Failure was defined as (i) graft re-rupture or (ii) significant pivot shift test at grade 2 or above at two years after index operation. RESULT: There were 20 ACLR-ALLRs, 36 DBACLRs and 29 SBACLRs. There was no difference in the pre-operative demographic data between the three groups. At two-year follow-up, there were no graft re-rupture for ACLR-ALLR (0%), five graft re-ruptures for DBACLR (16%) and four graft re-rupture for SBACLR (14%). For those patients with intact graft at two-year follow-up, the incidence of significant pivot shift was 12% (ACLR-ALLR), 12% (DBACLR) and 27% (SBACLR) respectively. When failure was defined as re-rupture and significant pivot shift, less failure was found in patients receiving combined ACLR and ALLR (12%) than DBACLR (26%) and SBACLR (35%). CONCLUSION: Patients receiving combined ACLR and ALLR had significantly less failure at two-year follow-up than patients receiving isolated ACLR (either DBACLR or SBACLR)