PURPOSE: Recent evidence has found the antero-lateral ligament (ALL) may play a role in stabilizing the knee, but its role in anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of the current study is to systematically review and meta-analyze the current evidence in the literature to ascertain whether ACL reconstruction combined with ALL reconstruction affects knee stability, re-rupture rates and patient-reported outcomes compared to ACL reconstructions performed alone. METHODS: A literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL + ALL reconstruction and ACL reconstruction alone were included. RESULTS: Six clinical trials (LOE I: I, LOE II: 2, LOE III: 3) with 729 patients were included, with a mean follow-up time of 34.2 (24-54.9) months. There was a significant difference in favor of combined ACL + ALL reconstruction for reduced re-rupture rate (2.4% vs 7.3%, p < 0.01), residual positive pivot shift rate (33.3% vs 11.4%, p < 0.01), and reduced KT-arthrometer evaluation (1.6 vs 2.6, p < 0.01). Combined ACL + ALL reconstruction resulted in improved IKDC scores (92.5 vs 87.8, p < 0.01), Lysholm scores (95.7 vs 91.2, p < 0.01) and Tegner scores (6.7 vs 5.7, p < 0.01). There was no significant difference in rate of return to play at the same level (54.3% vs 46.0%, n.s.). CONCLUSION: The current evidence suggests alongside soft tissue graft ACL reconstruction that concomitant ALL reconstruction improves clinical outcomes, with improved knee stability and lower re-rupture rates. LEVEL OF EVIDENCE: III.
PURPOSE: Recent evidence has found the antero-lateral ligament (ALL) may play a role in stabilizing the knee, but its role in anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of the current study is to systematically review and meta-analyze the current evidence in the literature to ascertain whether ACL reconstruction combined with ALL reconstruction affects knee stability, re-rupture rates and patient-reported outcomes compared to ACL reconstructions performed alone. METHODS: A literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL + ALL reconstruction and ACL reconstruction alone were included. RESULTS: Six clinical trials (LOE I: I, LOE II: 2, LOE III: 3) with 729 patients were included, with a mean follow-up time of 34.2 (24-54.9) months. There was a significant difference in favor of combined ACL + ALL reconstruction for reduced re-rupture rate (2.4% vs 7.3%, p < 0.01), residual positive pivot shift rate (33.3% vs 11.4%, p < 0.01), and reduced KT-arthrometer evaluation (1.6 vs 2.6, p < 0.01). Combined ACL + ALL reconstruction resulted in improved IKDC scores (92.5 vs 87.8, p < 0.01), Lysholm scores (95.7 vs 91.2, p < 0.01) and Tegner scores (6.7 vs 5.7, p < 0.01). There was no significant difference in rate of return to play at the same level (54.3% vs 46.0%, n.s.). CONCLUSION: The current evidence suggests alongside soft tissue graft ACL reconstruction that concomitant ALL reconstruction improves clinical outcomes, with improved knee stability and lower re-rupture rates. LEVEL OF EVIDENCE: III.
Authors: Brian M Devitt; Stuart W Bell; Clare L Ardern; Taylor Hartwig; Tabitha J Porter; Julian A Feller; Kate E Webster Journal: Orthop J Sports Med Date: 2017-10-24
Authors: Kirsten L Poehling-Monaghan; Hytham Salem; Kirsten E Ross; Eric Secrist; Michael C Ciccotti; Fotios Tjoumakaris; Michael G Ciccotti; Kevin B Freedman Journal: Orthop J Sports Med Date: 2017-06-14