Outcome of combined anatomic reconstruction of the anterior cruciate ligament with anterolateral ligament reconstruction versus with iliotibial band tenodesis

Abstract

Background
Isolated anterior cruciate ligament (ACL) tears without anterolateral structures injuries are treated successfully by isolated reconstruction of ACL. However, most ACL injuries are associated with the injuries of anterolateral stabilizers of the knee; mainly the iliotibial tract (ITB) and the anterolateral ligament (ALL). If ACL is only reconstructed in such a case, the incidence of postoperative rotational instability reaches 18%. New directions guided towards combined ACL reconstruction with extraarticular anatomical and nonanatomical reconstructions to improve knee rotation and translation and prevent pivot shift phenomena.


Patients and methods
We retrospectively reviewed all patients operated on for combined injuries of ACL and anterolateral stabilizers from February 2019 to February 2021. Preoperatively and postoperatively, all patients were examined clinically by knee stability tests: anterior drawer, Lachman, and pivot shift tests, applying the International Knee Documentation Committee score and return time to the sport.


Results
Forty patients were included with a mean age of 28 ± 8.33 years (range, 18–44 years). Patients were divided into two groups, group A 20 patients (18 males and two females) were treated by combined ACL with ALL reconstruction, and group B 20 patients (18 males and two females) were treated by combined ACL with ITB tenodesis. Sports injuries were the cause in 15 patients in group A and 14 in group B, while five injuries were due to nonsport activity in group A and six in group B. The mean follow-up period was 33.5 ± 2.1 months. Median postoperative subjective International Knee Documentation Committee scores in groups A and B were 95.4 and 94.25, respectively, without any statistically significant difference. Group A shows better postoperative improvement in pivot shift and one-leg hop test than group B with a significant difference (P<0.05).


Conclusion
No significant difference between ALL reconstruction or ITB tenodesis with ACL reconstruction according to subjective knee functions but there was a significant difference according to objective functions, also lateral knee pain was reported in group B and not observed in group A.