Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament Injury Compared to the Isolated Reconstruction of the Anterior Cruciate Ligament: A Meta-Analysis

Augusto Leão Bucar; Rodrigo Nunes de Albuquerque Pires; Rodrigo do Carmo Silva; Edicarlos André Cavalcante de Araujo; Messias Froes da Silva; Pedro Henrique Nunes de Araujo

doi:10.1055/s-0040-1709990

Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament Injury Compared to the Isolated Reconstruction of the Anterior Cruciate Ligament: A Meta-Analysis

Rev Bras Ortop (Sao Paulo). 2021 Feb;56(1):24-30. doi: 10.1055/s-0040-1709990. Epub 2020 Nov 2.

Authors

Augusto Leão Bucar¹, Rodrigo Nunes de Albuquerque Pires¹, Rodrigo do Carmo Silva¹, Edicarlos André Cavalcante de Araujo¹, Messias Froes da Silva¹, Pedro Henrique Nunes de Araujo¹

Affiliation

¹ Departamento de Ortopedia, Hospital das Forças Armadas, Brasília, DF, Brasil.

Abstract

The present research aims to compare the outcomes from the combined reconstruction of the anterior cruciate ligament (ACL) and of the anterolateral ligament (ALL) with the standard isolated ACL reconstruction in patients with chronic ACL injury. To do so, a meta-analysis was carried out to determine whether the combined ACL and ALL reconstruction would lead to a significant improvement in knee function according to the International Knee Documentation Committee (IKDC), the Lysholm test and KT-2000 evaluation scores and lower graft rupture rates in comparison with isolated reconstruction. To identify randomized controlled trials (RCTs) comparing the combined ACL and ALL reconstruction with the isolated ACL reconstruction, papers published between 2010 and 2019 were searched in the MEDLINE, EMBASE, SPORTDiscus, LILACS and Cochrane Central Register of Controlled Trials databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The stability of the knee joint is only marginally improved with the combined reconstruction of ACL and ALL, and both reconstruction techniques show functional results. The main outcomes sought were patient function and graft stability and rupture rates after ACL reconstruction. Out of the 421 studies identified, 6 were included in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, the studies included presented moderate-quality evidence. The graft rupture rate was higher in patients undergoing isolated ACL reconstruction (relative risk, 0.22; 95% confidence interval, 0.12 to 0.41; p < 0.00001).

Keywords: anterior cruciate ligament; anterolateral ligament; chronic lesion; ligament injury; rupture.

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