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Interlinked Hamstrings for Combined Anterolateral and Anterior Cruciate Ligament Reconstruction: A Novel Technique for ALL

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Abstract

Background

Anterolateral ligament (ALL) reconstruction provides rotational stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. The aim of this study was to assess the outcome of patients who underwent combined ACL and ALL reconstruction with a novel anatomic technique using hamstring tendon autograft and fixed loop suspensory device.

Methods

From 2016 to 2018, 25 patients who underwent combined reconstruction of ACL and ALL in our Institution were evaluated retrospectively. International Knee Documentation Committee (IKDC) Score, Tegner Lysholm Knee Score, grade of pivot shift was assessed at a final follow-up.

Results

Mean follow-up was 31.5 months (28–42). Mean IKDC (81.5) and Tegner Lysholm (82.8) Knee Scores improved significantly at a final follow-up, with all knees demonstrating negative pivot shift. All patients had good outcomes at 2 years follow-up with no graft failure and with no residual instability.

Conclusion

ACL and ALL reconstruction using this technique described for the anterolateral instability of the knee was satisfactory in our patients. This technique is simple, easily reproducible and avoids additional implants for ALL in the tibia.

Level of evidence

IV.

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References

  1. Mariscalco, M. W., Flanigan, D. C., Mitchell, J., Pedroza, A. D., Jones, M. H., Andrish, J. T., et al. (2013). The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy, 29(12), 1948–1953.

    Article  Google Scholar 

  2. Van Eck, C. F., Schkrohowsky, J. G., Working, Z. M., Irrgang, J. J., & Fu, F. H. (2012). Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. American Journal of Sports Medicine, 40(4), 800–807.

    Article  Google Scholar 

  3. Webster, K. E., Feller, J. A., Leigh, W. B., & Richmond, A. K. (2014). Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. American Journal of Sports Medicine, 42(3), 641–647.

    Article  Google Scholar 

  4. Chambat, P., Guier, C., Sonnery-Cottet, B., Fayard, J. M., & Thaunat, M. (2013). The evolution of ACL reconstruction over the last fifty years. IntOrthop, 37(2), 181–186.

    Google Scholar 

  5. Kraeutler, M. J., Welton, K. L., Chahla, J., LaPrade, R. F., & McCarty, E. C. (2018). Current concepts of the anterolateral ligament of the knee: anatomy, biomechanics, and reconstruction. American Journal of Sports Medicine, 46(5), 1235–1242.

    Article  Google Scholar 

  6. Chahla, J., Menge, T. J., Mitchell, J. J., Dean, C. S., & LaPrade, R. F. (2016). Anterolateral ligament reconstruction technique: an anatomic-based approach. Arthroscopy Techniques, 5(3), e453–e457.

    Article  Google Scholar 

  7. Sonnery-Cottet, B., Daggett, M., Helito, C. P., Fayard, J. M., & Thaunat, M. (2016). Combined anterior cruciate ligament and anterolateral ligament reconstruction. Arthroscopy Techniques, 5(6), e1253–e1259.

    Article  Google Scholar 

  8. Sonnery-Cottet, B., Barbosa, N. C., Tuteja, S., Daggett, M., Kajetanek, C., & Thaunat, M. (2016). Minimally invasive anterolateral ligament reconstruction in the setting of anterior cruciate ligament injury. Arthroscopy Techniques, 5(1), e211–e215.

    Article  Google Scholar 

  9. Helito, C. P., Bonadio, M. B., Gobbi, R. G., e Albuquerque RF, Pécora JR, Camanho GL, et al. (2015). Combined intra-and extra-articular reconstruction of the anterior cruciate ligament: The reconstruction of the knee anterolateral ligament. Arthroscopy Techniques, 4(3), e239–e244.

    Article  Google Scholar 

  10. Boutsiadis, A., Brossard, P., Panisset, J. C., Graveleau, N., & Barth, J. (2017). Minimally invasive combined anterior and anterolateral stabilization of the knee using hamstring tendons and adjustable-loop suspensory fixation device: surgical technique. Arthroscopy Techniques, 6(2), e419–e425.

    Article  Google Scholar 

  11. Sonnery-Cottet, B., Thaunat, M., Freychet, B., Pupim, B. H., Murphy, C. G., & Claes, S. (2015). Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. American Journal of Sports Medicine, 43(7), 1598–1605.

    Article  Google Scholar 

  12. Sonnery-Cottet, B., Saithna, A., Cavalier, M., Kajetanek, C., Temponi, E. F., Daggett, M., et al. (2017). Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI study group. American Journal of Sports Medicine, 45(7), 1547–1557.

    Article  Google Scholar 

  13. DePhillipo, N. N., Cinque, M. E., Chahla, J., Geeslin, A. G., & LaPrade, R. F. (2017). Anterolateral ligament reconstruction techniques, biomechanics, and clinical outcomes: a systematic review. Arthroscopy, 33(8), 1575–1583.

    Article  Google Scholar 

  14. Delaloye, J. R., Murar, J., Gonzalez, M., Amaral, T., Kakatkar, V., & Sonnery-Cottet, B. (2018). Clinical outcomes after combined anterior cruciate ligament and anterolateral ligament reconstruction. Techniques in Orthopaedics, 33(4), 225.

    Article  Google Scholar 

  15. Claes, S., Vereecke, E., Maes, M., Victor, J., Verdonk, P., & Bellemans, J. (2013). Anatomy of the anterolateral ligament of the knee. Journal of Anatomy, 223(4), 321–328.

    Article  Google Scholar 

  16. Vincent, J. P., Magnussen, R. A., Gezmez, F., Uguen, A., Jacobi, M., Weppe, F., et al. (2012). The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surgery, Sports Traumatology, Arthroscopy, 20(1), 147–152.

    Article  Google Scholar 

  17. Sonnery-Cottet, B., Vieira, T. D., & Ouanezar, H. (2019). Anterolateral ligament of the knee: diagnosis, indications, technique, outcomes. Arthroscopy, 35(2), 302–303.

    Article  Google Scholar 

  18. Ferretti, A. (2014). Extra-articular reconstruction in the anterior cruciate ligament deficient knee: a commentary. Joints, 2(1), 41.

    PubMed  PubMed Central  Google Scholar 

  19. de Castro, F. M., Zidan, F. F., Miduati, F. B., Fortuna, C. C., Mizutani, B. M., & Abdalla, R. J. (2016). Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings–technical note. Revista Brasileira de Ortopedia, 51(4), 466–470.

    Article  Google Scholar 

  20. Saragaglia, D., Pison, A., & Refaie, R. (2013). Lateral tenodesis combined with anterior cruciate ligament reconstruction using a unique semitendinosus and gracilis transplant. International Orthopaedics, 37(8), 1575–1581.

    Article  Google Scholar 

  21. Ibrahim, S. A., Shohdy, E. M., Marwan, Y., Ramadan, S. A., Almisfer, A. K., Mohammad, M. W., et al. (2017). Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: a randomized clinical trial. American Journal of Sports Medicine, 45(7), 1558–1566.

    Article  Google Scholar 

  22. Thaunat, M., Clowez, G., Saithna, A., Cavalier, M., Choudja, E., Vieira, T. D., et al. (2017). Reoperation rates after combined anterior cruciate ligament and anterolateral ligament reconstruction: a series of 548 patients from the SANTI Study Group with a minimum follow-up of 2 years. American Journal of Sports and Medicine, 45(11), 2569–2577.

    Article  Google Scholar 

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Correspondence to Ankit Jose.

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Sahanand, S., Jose, A., Kumar, G. et al. Interlinked Hamstrings for Combined Anterolateral and Anterior Cruciate Ligament Reconstruction: A Novel Technique for ALL. JOIO 56, 621–627 (2022). https://doi.org/10.1007/s43465-021-00551-x

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