Abstract
Objectives:
To compare the clinical outcomes of combined ACL and anterolateral ligament (ALL) reconstruction against isolated ACL reconstruction in a prospective randomized clinical trial (RCT). The hypothesis was that combined reconstructions would confer a lower graft failure rate, and lower overall re-operation rate than following isolated ACL reconstruction.
Methods:
A prospective RCT was conducted. Isolated ACL reconstruction using a "gold standard" BTB graft was compared against combined ACL and ALL reconstruction using hamstring tendons (HT + ALLR). Participants were randomized in a 1:1 ratio. Clinical outcomes were assessed regularly, up to a minimum 5 years. The primary outcome measure was the graft rupture rate. Reoperations, contralateral ACL rupture rates, PROMS and knee laxity parameters were also recorded.
Results:
592 patients with a mean follow-up of 61.2 months were included. Loss to follow up was 6.1%. Contralateral injury rates were not significantly different between groups (9,5%). 42 patients experienced ipsilateral graft failure (7.6%), with 12 (4.2%) in the HT + ALLR group and 30 (11%) in the isolated BTB group (p=0.0026). The risk of graft failure was 2.83-fold higher in the BTB group compared to the HT + ALL group ((OR 2.83; 95% CI: 1.43-5.95, p = 0.0025). Overall re-operations were 3.67 times higher in the BTB group (OR 3.67; 95% CI: 2.18-6.42, p < 0.0001). This also included cyclops syndrome (7.4% vs 1%, p=0.0002) and secondary meniscectomy (5.9% vs 2.1%, p=0.0197). There were no significant differences with respect to PROMS, RTS and knee laxity.
Conclusions:
Combined ACL and ALL reconstruction with hamstring tendons significantly outperforms isolated ACL reconstruction with a "gold standard" BTB graft, with respect to overall re-operation rates. These findings are due to higher rates of graft failure, cyclops syndrome and secondary meniscectomy in the BTB group.