Abstract
Objectives
To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed by magnetic resonance imaging (MRI) at a minimum five year follow up
Methods
A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (Control group) of ALL injury on preoperative MRI. Both groups underwent reconstruction of the ACL with autologous hamstrings grafts. The Lysholm and subjective International Knee Documentation Committee (IKDC) scores, KT-1000 and pivot shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury and presence of knee hyperextension were evaluated.
Results
A total of 156 patients were evaluated. No significant preoperative differences were found between the groups. In the postoperative evaluation, patients in the control group had a lower reconstruction failure rate (14.3% vs 4.6%; P = .049) and better clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.3; P < .0001). Although the pivot shift was similar, KT-1000 revealed worse results for the ALL injury group (2.8 +/- 1.4 mm) compared to the control group (1.9 +/- 1.3 mm) (p = 0.00018). Patients in the ALL injury group also presented a worsening of the knee instability from two to five years according to the KT-1000 (2.4 +/- 1.6 vs 2.8 +/- 1.4; p=0.038).
Conclusion
Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores. Also, knee stability tends to worsen from 2 to 5 years in cases of associated ALL injury.