Related Experiment Video
Updated: Sep 13, 2025
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Hamstring Anterior Cruciate Ligament Reconstruction With Anterolateral Ligament Reconstruction Is Associated With
Francesco Pettinari1, Alessandro Carrozzo2, Derrick Junhong Guo1
1Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France.
Purpose:
To compare combined anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) + anterolateral ligament reconstruction (ALLR) and bone-patellar tendon-bone with modified Lemaire lateral extra-articular tenodesis (BPTB + LET).
Methods:
Patients who underwent primary ACLR with BPTB + LET between January 2003 and December 2021 with a minimum follow-up of 2 years were propensity matched 1:4 with patients who underwent HT + ALLR during the same period. Graft rupture (defined as symptomatic graft rupture leading to revision surgery), reoperation rates (including any subsequent surgical intervention on the index knee), and postoperative side-to-side knee laxity were compared. Multivariable analysis using the Cox model was performed to examine the relationship between graft rupture, reinterventions, surgical procedure type, and all potential explanatory variables.
Results:
The study included 365 patients: 73 in the BPTB + LET group and 292 in the HT + ALLR group, with a mean follow-up of 162.6 ± 70.4 months for the BPTB + LET and 74.1 ± 33.5 months for the HT + ALLR group. The HT + ALLR group had a significantly lower reoperation rate than the BPTB + LET group (10.6% vs 24.7%; P < .0001). Graft rupture rates were not significantly different between the groups (3.4% in the HT + ALLR group vs 5.5% in the BPTB + LET group; P = .22). The BPTB + LET group had greater rates of secondary meniscal surgeries (12.3% vs 4.5%; P = .0006) and infections (4.1% vs 0.7%; P = .0075). Postoperative side-to-side knee laxity was comparable between groups (0.2 mm; P = .8495). Kaplan-Meier analysis demonstrated superior reoperation-free survival in the HT + ALLR group at all the time points. Multivariate Cox analysis confirmed that the BPTB + LET technique was independently associated with increased reoperation risk (hazard ratio 2.57; 95% confidence interval 1.15-5.74; P = .0209).
Conclusions:
Primary ACLR using HT + ALLR was associated with significantly lower reoperation rates compared with BPTB + LET. Specifically, the BPTB + LET group had significantly increased reoperation rate because of secondary meniscal procedures and infections. There were no significant differences in graft rupture rates between the 2 groups.
Level Of Evidence:
Level III, retrospective comparative case-series.
