Editorial Commentary: Proper Anterior Cruciate Ligament Graft Choice Mitigates Against the Need for Anterolateral Ligament Reconstruction

It is not coincidence that fervor surrounding anterolateral ligament (ALL) reconstruction increased as double-bundle anterior cruciate ligament reconstruction (ACLR) enthusiasm cooled. But perhaps we shifted our focus too soon, or perhaps we shifted our focus too much. But we must remember that the ACL is primary. Increases in ACL graft diameter by 1 or 2 mm can significantly increase graft strength and decrease revision rate. Biomechanical and clinical evidence suggests that quadriceps tendon ACLR and patellar tendon ACLR demonstrates less pivot shift phenomena than hamstring ACLR. In addition, As biologically active suture tapes become more mainstream, augmented allografts are an increasingly attractive option. Proper ACL graft choice mitigates against the need for ALL reconstruction. Risk factors for anterolateral rotatory instability may include low body mass index and lateral meniscal pathology, in addition to the well-known risks such as age, gender, activity level, and revision cases. Perhaps lateral extra-articular tenodesis should be reserved for high-risk cases.