Comparison of ACL and Anterolateral Ligament Reconstruction With Isolated ACL Reconstruction Using Hamstring Autograft: Outcomes in Young Female Patients With High-Grade Pivot Shift

Dhong Won Lee; Dong Hwan Lee; Seung Ik Cho; Sang Jin Yang; Woo Jong Kim; Joon Kyu Lee; Jin Goo Kim

doi:10.1177/23259671231178048

Comparison of ACL and Anterolateral Ligament Reconstruction With Isolated ACL Reconstruction Using Hamstring Autograft: Outcomes in Young Female Patients With High-Grade Pivot Shift

Orthop J Sports Med. 2023 Sep 26;11(9):23259671231178048. doi: 10.1177/23259671231178048. eCollection 2023 Sep.

Authors

Dhong Won Lee¹, Dong Hwan Lee¹, Seung Ik Cho², Sang Jin Yang³, Woo Jong Kim⁴, Joon Kyu Lee¹, Jin Goo Kim⁵

Affiliations

¹ Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
² Sports Medical Center, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
³ Department of Health and Exercise Management, Tongwon University, Gwangju-si, Gyeonggi-do, Republic of Korea.
⁴ Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea.
⁵ Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.

Abstract

Background: Inferior return to sports (RTS) and functional outcomes have been reported in women after anterior cruciate ligament reconstruction (ACLR).

Purpose/hypothesis: The purpose was to evaluate the results of combined ACLR and anterolateral ligament reconstruction (ALLR) in young women with a high-grade pivot shift (grade ≥2). It was hypothesized that combined ACLR and ALLR would result in better RTS and rotational stability than isolated ACLR.

Study design: Cohort study; Level of evidence, 3.

Methods: Two groups were retrospectively evaluated and compared. Group I (n = 39; mean age, 31.1 ± 5.7 years) underwent isolated ACLR using hamstring autografts; group C (n = 39; mean age, 30.4 ± 6.1 years) underwent combined ACLR and ALLR. Subjective outcome measures included the International Knee Documentation Committee subjective form, Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI). Objective tests included a KT-2000 arthrometer stress test, a pivot-shift test, an isokinetic strength test, a Y-balance test, and a single-leg hop test. A postoperative questionnaire was administered to determine the rates and types of RTS, quality of sports performance, and reinjury and satisfaction rates. Subjective scores and clinical tests were performed at 2 years. Magnetic resonance imaging and second-look arthroscopy were conducted during the 1- and 2-year follow-ups, respectively.

Results: The mean follow-up for groups I and C were 30.4 ± 3.9 and 29.3 ± 3.5 months, respectively (P = .194). Patients in group C had better anteroposterior (P = .001) and rotational (P = .005) stability and higher ACL-RSI scores (P = .025) than those in group I. Group C had higher composite and posteromedial reach scores on the Y-balance test than group I (P = .014 and P = .010, respectively). A total of 26 (66.7%) patients in group C and 17 (43.6%) in group I returned to their prior level of sports (P = .040). Rerupture of the ACL graft and contralateral ACL rupture occurred in 2 (5.1%) and 2 (5.1%) patients in group I, respectively, compared with no rerupture or contralateral ACL rupture in group C.

Conclusion: Combined ACLR and ALLR in young women with a high-grade pivot shift was associated with better knee stability parameters, dynamic postural stability, and psychological readiness to RTS than isolated ACLR.

Keywords: anterior cruciate ligament; anterolateral ligament; female; graft failure; pivot shift; return to sports.