Anterolateral Ligament Reconstruction Practice Patterns Across the United States
Joseph S Tramer1, Mohsin S Fidai1, Omar Kadri1
1Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Orthopaedic Journal of Sports Medicine
|December 12, 2018
Summary
Most surgeons do not routinely reconstruct the anterolateral ligament (ALL) during anterior cruciate ligament (ACL) surgery. Revision cases and severe pivot-shift tests are key indications for ALL reconstruction, with hamstring grafts being common.
Area of Science:
- Orthopaedic Surgery
- Sports Medicine
- Knee Biomechanics
Background:
- Anterolateral ligament (ALL) failure is a proposed cause of recurrent instability after anterior cruciate ligament (ACL) reconstruction.
- Multiple surgical techniques exist for addressing ALL pathology.
Purpose of the Study:
- To investigate current practice patterns of orthopaedic surgeons concerning the anterolateral ligament (ALL) during anterior cruciate ligament (ACL) reconstruction.
Main Methods:
- A cross-sectional study design was employed.
- An online survey was distributed to members of the American Orthopaedic Society for Sports Medicine in June-July 2017.
- Survey responses were analyzed using the survey website platform.
Main Results:
- Out of 3467 surgeons, 225 responded, with 86 completing all questions regarding ALL reconstruction.
- 38.2% of respondents perform ALL reconstruction concurrently with ACL reconstruction.
- Indications included grade III pivot-shift (46.0%) and revision ACL reconstruction (46.0%), with hamstring autograft being the most common technique (48.2%).
- Most surgeons (87.5%) do not alter postoperative rehabilitation protocols after ALL reconstruction.
- A significant majority (91.3%) anticipate an increase in ALL procedures.
Conclusions:
- The majority of surveyed surgeons do not routinely perform ALL reconstruction.
- Revision ACL reconstruction and grade III pivot shift are primary indications for lateral augmentation.
- While hamstring autograft is common, there is no consensus on the technique for ALL reconstruction.
- Understanding the ALL's role in knee stability is crucial for developing effective treatment strategies.
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