Summary
A combined ACL + ALLR does not increase the risk of OA in the lateral TF compartment when compared to an isolated ACLR.
Abstract
Background
Combined anterior cruciate ligament (ACL) and anterolateral ligament reconstruction(ALLR) has demonstrated reduced risk of graft re-rupture compared to isolated ACL reconstruction (ACLR). However, concerns remain that the risk of osteoarthritis (OA) may be increased by its addition.
Purpose/Hypothesis: The aim of this study was to evaluate the incidence of OA with isolated ACLR in comparison to ACL + ALLR at medium term follow-up. We hypothesized that there would be no differences between the groups.
Study Design: Non-Randomized Controlled Clinical Trial. Level of Evidence – III.
Methods
Patients who underwent ACL + ALLR between January 2011 and March 2012 were propensity matched to patients who underwent isolated ACLR. Long term radiographic evaluation was performed using the International Knee Documentation Committee (IKDC) radiographic OA grading scale, modified Kellgren-Lawrence grade and the surface-fit method to assess percentage of joint space narrowing. Clinical outcomes were assessed with the IKDC score, Knee Injury and Osteoarthritis Outcome Score (KOOS) , Lysholm score, Tegner score and ACL return to sport after injury score.
Results
A total of 80 patients (42 ACL + ALL and 38 isolated ACLR) were analyzed with a mean follow-up of 104 months. There was no significant difference between groups for joint space narrowing in the medial or lateral tibiofemoral (TF) or lateral patellofemoral (PF) compartments. However 37.8% in the isolated ACLR group versus 12.8% in the ACLR + ALLR group had narrowing of the medial PF compartment (P = .0118). A lateral meniscus tear increased the risk of lateral TF narrowing by 4.9 times (4.9 ; 95% C.I 1.547- 19.367; P= .0123). The risk of medial PF narrowing was greater than fourfold with an isolated ACLR (HR 4.8; 95% C.I 1.44 – 19.05, P= .0179). Comparing the isolated ACLR to the ACLR+ALL group, secondary menisectomy rate was 13.2% versus 11.9% (n.s). There was no difference between groups in KOOS, Tegner or IKDC scores.
Conclusion
A combined ACL + ALLR does not increase the risk of OA in the lateral TF compartment when compared to an isolated ACLR. Isolated ACLR using bone-patella tendon-bone (BPTB) was associated with a significantly increased risk of medial PF joint space narrowing.