Summary
Combined ACLR and ALL reconstruction was associated with significantly reduced graft failure rates as well as a lower incidence of reoperations and complications when compared to the gold-standard BPTB.
Abstract
Background
Anterior cruciate ligament (ACL) ruptures are amongst the most common sports injuries. Studies suggest that adding an anterolateral ligament reconstruction (ALLR) to anterior cruciate ligament reconstruction (ACLR) may reduce graft failure rate. However, evidence from randomized clinical trials (RCT) is currently limited.
Methods
A prospective RCT with a follow-up of 5 years, comparing isolated ACLR (current gold-standard) against combined ACLR+ALLR was performed. The primary outcome measure was the graft rupture rate. Adverse events, re-operations, patient-reported outcome measures (PROMS), return to sport (RTS) rate and knee laxity parameters were recorded. Graft failure and time-to-event distributions were analyzed with Kaplan-Meier and Cox proportional hazards models. ClinicalTrials.gov, NCT03740022.
Results
556 patients were included with a median follow-up of 64.7 months. Graft failure occurred in 10.3% (95% confidence interval [CI], 6.7 to 13.9) in the ACLR group and 4.2% (95% CI, 1.9 to 6.6) in the ACLR+ALLR group with an adjusted odds ratio of 2.58 (95% CI, 1.29 to 5.45; P=0.006). Reoperations rates were 23% in the ACLR group compared to 7% in the ACLR+ALLR group (P< 0.001). No significant differences were observed in PROMS, RTS rate or knee laxity between groups.
Conclusions
Combined ACLR and ALL reconstruction was associated with significantly reduced graft failure rates as well as a lower incidence of reoperations and complications when compared to isolated ACLR.