Hamstring ACL Reconstruction with and without Anterolateral Ligament Reconstruction in Young Athletes

OrthoMedia ◽  
2022 ◽  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Anterolateral Ligament ◽  
Young Athletes ◽  
Anterolateral Ligament Reconstruction

scholarly journals Anterolateral ligament reconstruction associated with hamstring ACL reconstruction reduces the rate of repeat graft ruptures in a population of young athletes at follow-up in 2 years

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0001
Author(s):  
Pierre Laboudie ◽  
Adil Douiri ◽  
Nicolas Graveleau ◽  
Nicolas Bouguennec ◽  
Alexandre Biset
Keyword(s):  
Acl Reconstruction ◽  
Survival Data ◽  
Ligament Reconstruction ◽  
Group Versus ◽  
Anterolateral Ligament ◽  
Return To Sports ◽  
Young Athletes ◽  
Anterolateral Ligament Reconstruction ◽  
Semitendinosus Graft

Objectives: The rate of repeat graft ruptures in young athletes is a major concern after ACL reconstruction. Our objective was to evaluate the association between two reconstruction techniques and repeat ruptures, repeat surgery, return to sports and complications in center playing sportspersons younger than 20 years of age. Methods: A prospective study was conducted in patients under 20 years of age who were center players and who had primary ACL reconstruction with a semitendinosus graft (ST4) by a suspension technique, or a semitendinosus graft with suspension technique combined with independent anterolateral ligament reconstruction (ST4+ALL). Patients were followed up in a minimum of 2 years. Survival data from the Kaplan-Meier analysis were used as well as multivariate logistic regression to identify risk factors for repeat rupture. 203 patients (mean age, 16.3±2 years) with a mean follow-up of 40.6±11 months (24-63 months) were included. There were 101 patients in the ST4 group, and 102 patients in the ST4+ALL group. Results: There was a 9.9% repeat in ruptures in the ST4 group versus 5.8% in the ST4+ALL group (p=0.288). The rate of repeat ruptures in the ST4+ALL group was 5 times lower than in the ST4 group in multivariate analysis (odds ratio [OR], 0.201; 95% CI, 0.044-0.922). There was a 6.9% rate of secondary meniscal procedures in the ST4 group versus 1.9% in the ST4+ALL group (p=0.101). Differential laxity was 1.3±1.3 (-2 - 5) in the ST4 group versus 0.9±1.3 (-6 - 4.8) in the ST4+ALL group (p=0.008). There was a 42.2% return to the same sports level in the ST4 group versus 52% in the ST4+ALL group (p=0.178). The mean postoperative scores at the last follow-up were: IKDC: 83.3±14.3 and 82±14.4; ACL-RSI: 69.8±23.5 and 67.4±22.4; Tegner: 6.6±1.8 and 6.9±1.8 and Lysholm: 86.4±15.2 and 86±16.8; for ST4 and ST4+ALL groups, respectively. Conclusion: Anterolateral ligament reconstruction reduces the rate of repeat ruptures in athletes younger than 20 years of age after a semitendinosus graft. It is also associated with fewer secondary meniscal procedures, better control of laxity and a better rate of return to the same level of sports without further complications.

scholarly journals Anterolateral Ligament Reconstruction: A Possible Option in the Therapeutic Arsenal for Persistent Rotatory Instability After ACL Reconstruction

2018 ◽  
Vol 6 (1) ◽  
pp. 232596711775134 ◽  
Author(s):  
Camilo Partezani Helito ◽  
Adnan Saithna ◽  
Marcelo B. Bonadio ◽  
Matt Daggett ◽  
Edoardo Monaco ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Anterolateral Ligament ◽  
Rotatory Instability ◽  
Anterolateral Ligament Reconstruction

Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group

2020 ◽  
Author(s):  
Adnan Saithna ◽  
Matt Daggett ◽  
Camilo Partezani Helito ◽  
Edoardo Monaco ◽  
Florent Franck ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Lower Risk ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Anterolateral Ligament ◽  
Narrative Review ◽  
Acl Graft ◽  
Anterolateral Ligament Reconstruction ◽  
Graft Rupture

AbstractLateral extraarticular procedures (LEAPs) in the anterior cruciate ligament (ACL)-injured knee were widely abandoned in the 1990s but have seen a recent resurgence. The aim of this review was to demonstrate that anterolateral ligament reconstruction (ALLR) is associated with evidence of significant advantages and no evidence of historical concerns. A narrative review of the literature was performed. Combined ACL + ALLR is associated with improved outcomes when compared against isolated ACL reconstruction, including a significantly lower risk of ACL graft rupture (hazard ratio [HR]: 0.327, 95% CI: 0.130–0.758), a significantly lower risk of reoperation for secondary meniscectomy following medial meniscal repair at the time of ACL reconstruction (HR: 0.443, 95% CI: 0.218–0.866), significantly increased likelihood of return to the preinjury level of sport following primary (odds ratio [OR]: 1.938, 95% CI: 1.174–3.224) and revision ACL reconstruction (57.1 vs. 25.6%, respectively; p = 0.008), and in chronic ACL injuries, less residual pivot shift (9.1 vs. 35.3%, p = 0.011), and better IKDC (92.7 ± 5.9 vs. 87.1 ± 9.0, p = 0.0013) and Lysholm (95.4 ± 5.3 vs. 90.0 ± 7.1, p < 0.0001) scores, and no evidence of historical concerns. Combined ACLR + ALLR is associated with excellent clinical outcomes with no evidence of the adverse events that led to the historical widespread abandonment of other types of LEAP. Specifically, comparative series have demonstrated significant advantages of ALLR when compared against isolated ACLR with respect to reduced rates of ACL graft rupture, secondary meniscectomy, persistent instability, and significantly improved functional outcomes and improved return to sport metrics.

Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

2021 ◽  
pp. 036354652110289
Author(s):  
Bertrand Sonnery-Cottet ◽  
Ibrahim Haidar ◽  
Johnny Rayes ◽  
Thomas Fradin ◽  
Cedric Ngbilo ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Anterolateral Ligament ◽  
Activity Level ◽  
Acl Graft ◽  
Anterolateral Ligament Reconstruction ◽  
Graft Rupture ◽  
The Mean

Background: Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALLR) over isolated ACL reconstruction (ACLR) with respect to reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to sports. However, no long-term studies exist. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated ACLR versus ACL+ALLR at long-term follow-up. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing primary ACL+ALLR between January 2011 and March 2012 were propensity matched in a 1:1 ratio to patients who underwent isolated ACLR during the same period. A combination of face-to-face and telemedicine postoperative follow-up was undertaken. At the end of the study period (March 2020), medical notes and a final telemedicine interview were used to determine whether patients had experienced any complications or reoperations. The Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lysholm score, and Tegner score were collected for all patients. Graft survivorship was assessed using Kaplan-Meier analysis. Logistic regression was performed to account for the potential effect of activity level on graft rupture rates. Results: A total of 86 matched pairs were included in the study. The mean ± SD age was 32.2 ± 8.8 years (range, 22-67 years) in the ACL+ALLR group and 34.7 ± 8.5 years (range, 21-61 years) in the isolated ACLR group. The mean duration of follow-up was 104.33 ± 3.74 months (range, 97-111 months). Patients who underwent combined ACL+ALLR versus isolated ACLR experienced significantly better ACL graft survivorship (96.5% vs 82.6%, respectively; P = .0027), lower overall rates of reoperation (15.3% vs 32.6%; P < .05), and lower rates of revision ACLR (3.5% vs 17.4%; P < .05). Patients undergoing isolated ACLR were at >5-fold greater risk of graft rupture (odds ratio, 5.549; 95% CI, 1.431-21.511; P = .0132), regardless of their preinjury activity level. There were no significant differences between groups with respect to other complications or any clinically important differences in patient-reported outcome measures. Conclusion: Patients who underwent combined ACL+ALLR experienced significantly better long-term ACL graft survivorship, lower overall rates of reoperation, and no increase in complications compared with patients who underwent isolated ACLR. Further, patients who underwent isolated ACLR had a >5-fold increased risk of undergoing revision surgery at a mean follow-up of 104.3 months.

scholarly journals Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction

2019 ◽  
Vol 8 (1) ◽  
pp. e23-e29 ◽  
Author(s):  
Jean-Romain Delaloye ◽  
Jozef Murar ◽  
Thais Dutra Vieira ◽  
Adnan Saithna ◽  
Johannes Barth ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Ligament Repair ◽  
Anterolateral Ligament Reconstruction ◽  
Anterior Cruciate Ligament Repair ◽  
Anterior Cruciate

scholarly journals Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction

2016 ◽  
Vol 5 (6) ◽  
pp. e1253-e1259 ◽  
Author(s):  
Bertrand Sonnery-Cottet ◽  
Matt Daggett ◽  
Camilo Partezani Helito ◽  
Jean-Marie Fayard ◽  
Mathieu Thaunat
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Anterolateral Ligament Reconstruction ◽  
Anterior Cruciate

scholarly journals Anterolateral Ligament Reconstruction Protects the Repaired Medial Meniscus: A Comparative Study of 383 Anterior Cruciate Ligament Reconstructions From the SANTI Study Group With a Minimum Follow-up of 2 Years

2018 ◽  
Vol 46 (8) ◽  
pp. 1819-1826 ◽  
Author(s):  
Bertrand Sonnery-Cottet ◽  
Adnan Saithna ◽  
William G. Blakeney ◽  
Herve Ouanezar ◽  
Amrut Borade ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Anterolateral Ligament ◽  
Hamstring Tendons ◽  
Anterolateral Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background: The prevalence of osteoarthritis after successful meniscal repair is significantly less than that after failed meniscal repair. Purpose: To determine whether the addition of anterolateral ligament reconstruction (ALLR) confers a protective effect on medial meniscal repair performed at the time of anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective analysis of prospectively collected data was performed to include all patients who had undergone primary ACLR with concomitant posterior horn medial meniscal repair through a posteromedial portal between January 2013 and August 2015. ACLR autograft choice was bone–patellar tendon–bone, hamstring tendons (or quadrupled hamstring tendons), or quadrupled semitendinosus tendon graft with or without ALLR. At the end of the study period, all patients were contacted to determine if they had undergone reoperation. A Kaplan-Meier survival curve was plotted, and a Cox proportional hazards regression model was used to perform multivariate analysis. Results: A total of 383 patients (mean ± SD age, 27.4 ± 9.2 years) were included with a mean follow-up of 37.4 months (range, 24-54.9 months): 194 patients underwent an isolated ACLR, and 189 underwent a combined ACLR + ALLR. At final follow-up, there was no significant difference between groups in postoperative side-to-side laxity (isolated ACLR group, 0.9 ± 0.9 mm [min to max, –1 to 3]; ACLR + ALLR group, 0.8 ± 1.0 mm [min to max, –2 to 3]; P = .2120) or Lysholm score (isolated ACLR group, 93.0 [95% CI, 91.3-94.7]; ACLR + ALLR group, 93.7 [95% CI, 92.3-95.1]; P = .556). Forty-three patients (11.2%) underwent reoperation for failure of the medial meniscal repair or a new tear. The survival rates of meniscal repair at 36 months were 91.2% (95% CI, 85.4%-94.8) in the ACLR + ALLR group and 83.8% (95% CI, 77.1%-88.7%; P = .033) in the ACLR group. The probability of failure of medial meniscal repair was >2 times lower in patients with ACLR + ALLR as compared with patients with isolated ACLR (hazard ratio, 0.443; 95% CI, 0.218-0.866). No other prognosticators of meniscal repair failure were identified. Conclusion: Combined ACLR and ALLR is associated with a significantly lower rate of failure of medial meniscal repairs when compared with those performed at the time of isolated ACLR.

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