Comparable outcomes following combined ACL and ALL reconstruction using a 1-strand versus 2-strand back-and-forth...

Area of Science:

• Orthopedic surgery
• Sports medicine
• Biomechanical engineering

Background:

• Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) injuries often require surgical reconstruction.
• Hamstring grafts are commonly used for ACL reconstruction, but optimal techniques for combined ACL and ALL reconstruction are still debated.
• Understanding the biomechanical and clinical differences between graft techniques is crucial for improving patient outcomes.

Purpose of the Study:

• To compare post-operative laxity and clinical outcomes of combined ACL and ALL reconstruction using hamstring grafts with a 1-strand versus a 2-strand back-and-forth technique.
• To evaluate the effectiveness of each technique in restoring knee stability and function.

Main Methods:

• Retrospective assessment of 348 patients (2-strand) and 130 patients (1-strand) undergoing combined ACL and ALL reconstruction.
• Propensity score matching created comparable cohorts (70 patients each).
• Pre- and post-operative assessments included KOOS-12, Lysholm, Tegner, ACL-RSI scores, physical exams (jerk test, Lachman grade), and arthrometer measurements (anterior translation, internal rotation).

Main Results:

• After propensity score matching and accounting for follow-up losses and revisions, 58 patients (2-strand) and 59 patients (1-strand) were analyzed.
• No significant differences were found between the 1-strand and 2-strand groups in post-operative differential laxity (anterior translation, internal rotation).
• Clinical outcome scores (KOOS-12, ACL-RSI, Lysholm, Tegner) and retear rates were comparable between the two techniques.

Conclusions:

• The 1-strand and 2-strand back-and-forth hamstring graft techniques for combined ACL and ALL reconstruction yield similar post-operative laxity.
• Both techniques demonstrate comparable functional and clinical outcomes, including return to sport and activity levels.
• These findings suggest that both 1-strand and 2-strand techniques are equally effective for restoring knee stability and function in combined ACL and ALL reconstructions.