Combined anterior cruciate ligament and anterolateral ligament reconstruction using an adjustable-loop device provides similar short-term clinical outcomes compared with isolated reconstruction.

Abstract

Residual rotational laxity remains a relevant clinical concern after anterior cruciate ligament (ACL) reconstruction. Combined ACL and anterolateral ligament (ALL) reconstruction has been proposed to improve control of rotational laxity; however, clinical outcome data supporting techniques using adjustable-loop femoral fixation for combined reconstruction remain limited. This study aimed to compare short-term clinical outcomes and knee laxity between combined ACL + ALL reconstruction and isolated ACL reconstruction. We hypothesized that combined reconstruction would demonstrate a lower frequency of residual postoperative pivot shift. A retrospective, non-randomized comparative study evaluated patients undergoing primary ACL reconstruction at a single institution. Of 48 eligible patients, 42 were included after exclusion criteria and loss to follow-up: 21 treated with combined ACL + ALL reconstruction and 21 with isolated ACL reconstruction. All procedures used hamstring tendon autografts and adjustable-loop femoral fixation. Overall follow-up ranged from 18 to 30 months. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores, and knee laxity was evaluated clinically. Multivariable linear regression was performed to adjust for baseline differences. Both groups demonstrated statistically significant improvement in IKDC and Lysholm scores from preoperative to postoperative evaluation (all p < 0.001). Postoperative functional scores were slightly higher in the combined ACL + ALL group; however, these differences were small and not clinically meaningful. Residual pivot shift was observed in 1 patient (4.8%) in the combined group and 6 patients (28.6%) in the isolated ACL group (RR= 6.0; 95% confidence interval, 0.79-45.63); this difference did not reach statistical significance. In the multivariable analysis, surgical technique was not identified as an independent predictor of postoperative functional outcomes. Lower preoperative IKDC scores were independently associated with greater postoperative functional improvement (ΔIKDC) (β = -0.99, p < 0.001). No patients required re-intervention or experienced graft re-rupture during follow-up. At short-term follow-up, combined ACL + ALL reconstruction using an adjustable-loop device resulted in functional outcomes comparable to isolated ACL reconstruction. Functional improvement (ΔIKDC) was primarily associated with baseline functional status rather than surgical technique. Residual postoperative pivot shift was less frequent in the combined group but did not reach statistical significance, and the small differences in patient-reported outcomes are unlikely to be clinically meaningful. Level III.