Abstract
PurposeHigh-grade pivot shift in the anterior cruciate ligament (ACL) injured knee is a risk factor for postoperative residual pivot shift. Procedures in addition to ACL reconstruction such as anterolateral ligament (ALL) reconstruction have been performed for patients with a high-risk of residual pivot shift. The aim of this study was to investigate the effect of the addition of ALL reconstruction to primary double-bundle ACL reconstruction in patients with preoperative high-grade pivot shift to improve stability as evaluated by quantitative measurement.MethodsPatients with ACL injuries who showed preoperative grade 3 subjective pivot shift and who underwent primary double-bundle ACL reconstruction combined with ALL reconstructions were retrospectively enrolled. Anterior tibial translation (ATT) in the Lachman test, and acceleration and external rotational angular velocity (ERAV) in the pivot shift were measured as quantitative values. Quantitative values before surgical intervention for ACL-injured knees (ACLD) and uninjured contralateral knees (intact), after temporary fixation of the isolated ACL grafts (ACLR), and subsequently after temporary fixation of both ACL and ALL grafts (ACLR + ALLR) were measured with the patient under general anaesthesia.ResultsIn total, 18 patients were included. The ATT was lower in ACLR and ACLR + ALLR than in intact (P = .008 and .005), while there was no significant difference between ACLR and ACLR + ALLR (P > .05). The acceleration of ACLR + ALLR was lower than that for ACLR (P = .008), while there was no significant difference between intact and ACLR or ACLR + ALLR (P > .05). The ERAV of ACLR was higher than that of intact (P < .001), while that of ACLR + ALLR was lower than that of ACLR (P < 0.001), and there was no significant difference in ERAV between intact and ACLR + ALLR (P > 0.05).ConclusionAccording to quantitative assessment of the pivot shift, the addition of ALL reconstruction to primary double-bundle ACL reconstruction improved residual knee instability and restored knee stability during surgery. Combination of ALL reconstruction with primary double-bundle ACL reconstruction was effective for patients with ACL injuries exhibiting a preoperative grade 3 subjective pivot shift.Level of evidenceIV
Highlights
The anterior cruciate ligament (ACL) is frequently injured in athletic populations
A negative pivot shift in subjective evaluation, which was indicated as grade 0, was confirmed in all cases after temporary fixations of the isolated ACL grafts and both the ACL and anterolateral ligament (ALL) grafts
These findings were supported by following evidence: (1) the external rotational angular velocity (ERAV) of ACL grafts (ACLR) were higher than intact, while (2) both acceleration and the ERAV of ACLR + ALLR were lower than ACLR and there were no significant differences between ACLR + ALLR and intact
Summary
The anterior cruciate ligament (ACL) is frequently injured in athletic populations. ACL reconstruction has been considered a successful treatment for controlling anteroposterior and rotational stability, evaluated using the Lachman test and pivot-shift test, respectively. Additional procedures to ACL reconstruction have been reported. These include anterolateral ligament (ALL) reconstruction [27], anterolateral tenodesis [25] and anterolateral structure augmentation [29] for patients with risk factors, such as revision cases [16], young patients [27], pivoting sports [27], athletes [8], chronic ACL tears [9], hyperlaxity patients [10], and preoperative grade 3 pivot shift [28]. Few studies have investigated the effects of combined double-bundle ACL and ALL reconstruction or the quantitative measurement of instability at the time of additional ALL reconstruction [29]
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