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Double-Bundle ACL Reconstruction Combined with ALLR Shows Promising Results

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Amidst growing concerns over the effectiveness of surgical techniques for anterior cruciate ligament (ACL) reconstruction, a new study sheds light on the potential benefits of combining double-bundle (DB) ACL reconstruction with anterolateral ligament reconstruction (ALLR). This approach could be a game-changer, especially for patients at a high risk of ACL failure, by improving clinical and radiological outcomes.

A recent retrospective cohort study has revealed that double-bundle (DB) anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament reconstruction (ALLR) offers satisfactory clinical outcomes for patients at high risk of ACL failure. The primary focus was on graft failure rates, knee stability, and patient-reported outcome measures (PROMs). The study encompassed 52 patients, with a mean age of 26.1 years, and observed them for an average of 28.9 months.

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Clinical Outcomes and Stability

Key preoperative risk factors, such as femorotibial angle (FTA), lateral tibial slope (LTS), medial tibial slope (MTS), and meniscal tears, were evaluated through X-ray and MRI. The study found that 57.8% of the patients had lateral meniscus tears, and 61.0% exhibited a grade 2-3 pivot shift before surgery. Post-surgery, no graft failures or revision cases were reported, and approximately 90.4% of the patients exhibited a negative pivot shift.

Patient-Reported Outcomes

The patients recorded high scores in the Lysholm and Tegner activity assessments, with average scores of 92.5 and 5.1, respectively. Interestingly, the medial meniscus tear group exhibited a significantly smaller FTA than the intact group, while no significant differences in PROMs were detected between groups with or without lateral meniscus tears or between those with varying MTS or LTS levels.

From a market access perspective, the study highlights the potential for this combined surgical approach to become a standard practice, provided it demonstrates consistent, favorable outcomes in broader patient populations. The absence of graft failures during the follow-up period is particularly noteworthy, suggesting that this technique could offer enhanced durability and stability compared to traditional methods.

Key Inferences

The study’s findings lead to several valuable insights:

  • The combination of DB ACLR and ALLR appears to significantly minimize postoperative pivot shifts, enhancing knee stability.
  • High Lysholm and Tegner scores indicate substantial patient satisfaction and functional recovery.
  • The lack of graft failures strengthens the case for adopting this combined technique in clinical practice.
  • The study provides a foundation for further research into the long-term benefits and cost-effectiveness of this approach.

In conclusion, DB ACLR combined with ALLR is shown to deliver robust clinical outcomes for patients at high risk of ACL failure. The technique’s ability to reduce postoperative pivot shifts and maintain graft integrity over an extended follow-up period suggests it could be a viable option for enhancing patient outcomes and potentially improving market access for advanced ACL reconstruction methods.

Original Article:

BMC Musculoskelet Disord. 2024 Jul 29;25(1):594. doi: 10.1186/s12891-024-07703-8.

ABSTRACT

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BACKGROUND: We investigated whether double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (ACLR) combined with anterolateral ligament reconstruction (ALLR) improved clinical and radiological outcomes in patients at high risk of ACL failure. The primary outcome was graft failure, and secondary outcomes included knee stability and patient-reported outcome measures (PROMs).

PATIENTS AND METHODS: Fifty-two patients who underwent DB ACLR combined with ALLR were included in this retrospective cohort study. Preoperative risk factors, including femorotibial angle (FTA), lateral tibial slope (LTS), medial tibial slope (MTS), and meniscal tears, were assessed using X-ray and magnetic resonance imaging (MRI). The grade of post-operative pivot shift, Lysholm score, and Tegner activity score were used to assess clinical outcomes. The minimum follow up duration was 2 years.

RESULTS: The cohort (mean age, 26.1 ± 9.4 years; 51.9% male) had a mean follow-up duration of 28.9 ± 3.4 months. Preoperatively, 57.8% had lateral meniscus (LM) tears, and 61.0% had a grade 2-3 pivot shift. Postoperatively, no graft failures or revision cases occurred during follow-up. Approximately 90.4% of the patients exhibited a negative pivot shift (p < 0.001), with Lysholm and Tegner activity scores of 92.5 ± 6.1 and 5.1 ± 2.0. The medial meniscus (MM) tear group had a significantly smaller FTA than the intact group (p = 0.043). No significant differences in PROMs were found between the LM tear and intact LM groups or between the high and low MTS or LTS groups (p = n.s.).

CONCLUSION: DB ACLR combined with ALLR had satisfactory clinical outcomes in patients at high risk of ACL failure, with no graft failures observed during a mean follow-up duration of 2.4 years. The technique effectively reduced the postoperative pivot shift, regardless of preoperative risk factors.

STUDY DESIGN: Level IV, retrospective therapeutic case-series.

TRAIL REGISTRATION: ethical approval number, 202300134B0; ethical committee, the Institutional Review Board of Chang Gung Medical Foundation.

PMID:39069639 | DOI:10.1186/s12891-024-07703-8


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