Rotational stability after ACL reconstruction using anatomic double bundle technique versus anatomic single bundle technique plus anterolateral ligament augmentation

Abstract

BackgroundA residual pivot shift seen in up to quarter of ACL reconstructions using anatomic single bundle (ASB) technique. Light has been thrown on the importance of the Posterolateral (PL) bundle and its role in rotational stability, hence the concept of anatomic double bundle (ADB) reconstruction. Anterolateral ligament (ALL) reconstruction; an added extra-articular procedure, is proposed to be responsible for rotational knee stability. The aim of this study was to assess functional outcomes and rotational stability of the knee after ADB versus ASB reconstruction plus ALL augmentation. Patients and methodsBetween January 2015 and December 2015, a randomized controlled trial (RCT) was conducted on 40 patients suffering from chronic ACL injuries or acute injuries with high grade knee jerk or are high demand athletes. Twenty patients (group A) were treated with ASB ACL reconstruction and ALL augmentation. The other 20 patients (group B) underwent ADB ACL reconstructions. All patients were assessed pre and post-operatively using the Lysholm and IKDC (international knee documentation committee) scores and KT-1000 arthrometer. At the final follow-up, internal rotation kinematics of the knee was assessed using motion analysis in a gait lab. ResultsAll were followed-up for a mean of two years. At the final follow-up, there was no statistically significant difference regarding the total Lysholm score, IKDC score and KT-1000 side to side difference; P-values 0.821, 0.732, 0.533 respectively. Group ‘A’ demonstrated better rotational stability than group ‘B’ as measured from internal tibial rotation angle with a p-value of 0.001. ConclusionALL augmentation is an added extra-articular procedure that superseded ADB reconstruction in achieveing better knee internal rotation kinematics. Level of evidence: II.