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Clinical experience with combined reconstruction of the anterior cruciate and anterolateral ligaments of the knee in sportsmen

  • Evgeniy Nikolaevich Goncharov
  • Oleg Aleksandrovich KovalEmail author
  • Vadim Erikovich Dubrov
  • Eduard Nikolaevich Bezuglov
  • Anastasiya Mikhaylovna Filimonova
  • Nikolay Gavriilovich Goncharov
Original Paper
  • 22 Downloads

Abstract

Background

Rupture of the anterior cruciate ligament (ACL) is one of the most common sports injuries of the knee joint. Today, we have a large number of approaches to arthroscopic reconstruction of the anterior cruciate ligament that lead to successful outcomes and allow the patients to return to a significant level of activity post-operatively. Nevertheless, the return to competitions rate stays relatively low. The functional state is thought to be dependent on rotational and anteroposterior stability of the knee. These data encourage search for methods of additional stabilization of the knee joint, one of them being extra-articular tenodesis, or reconstruction of anterolateral ligament of the knee.

The aim of the study

To evaluate medium-term results of combined simultaneous arthroscopic reconstruction of anterior cruciate ligament and anterolateral ligament of the knee joint in sportsmen and to access the probability of return to competitions.

Materials and methods

The surgeries were performed in 2014–2015 in 50 patients who fulfilled the entry criteria: 20 patients (including 10 professional sportsmen) underwent arthroscopic ACL reconstruction together with reconstruction of anterolateral ligament—group 1 (main group), and 30 patients (including 10 professional sportsmen) underwent arthroscopic ACL reconstruction—group 2 (control group).

Results

Group 1: All patients of group 1 were able to return to the pre-operative sports level in two years after the surgery. The mean Tegner Lysholm score was 72.6 ± 6.45 (hereinafter, SE—standard error) before the surgery and 97.4 ± 1.18 after the surgery. The mean IKDC score was 63.1 ± 4.8% before the surgery and 96.3 ± 1.8% after the surgery. Group 2: 20 of 30 patients (66.7%) returned to the pre-operative level of activity and returned to competitions (if they were professional sportsmen) in a year after the surgery. Five of ten patients (50%) (professional sportsmen) returned to competitions. Fifteen of 20 patients (75%) (amateur sportsmen) also returned to competitions. The mean pre-operative Tegner Lysholm score was 69.6 ± 3.5, and the mean post-operative score was 92.1 ± 3.9. The mean pre-operative IKDC score was 73.4 ± 3.2%, and the mean post-operative score was 90.3 ± 3.7%.

Conclusion

The results of the study show that more patients with higher functional demands and more professional sportsmen returned to sports. Despite the results of our and other foreign studies, a need remains for studies that will compare outcomes of ALL reconstruction with the same surgical technique in homogenous groups of patients.

Keywords

Anterolateral ligament Sport Back to sport Knee instability Anterior cruciate ligament Reconstruction of anterior cruciate ligament Reconstruction of anterolateral ligament 

Notes

Funding information

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Sanders TL, Maradit KH, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ (2016) Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 44(6):1502–1507.  https://doi.org/10.1177/0363546516629944 CrossRefGoogle Scholar
  2. 2.
    Lazishvili GD, Kuzmenko VV, Girshin VE (1997) Arthroscopic reconstruction of the anterior cruciate ligament of the knee. Vestnik travmotologii and opthopedii im. Priorova N.N., 1:23–27. (in Russian)Google Scholar
  3. 3.
    Fedoruk GV, Goleva AV, Brovkin SS, Nevzorov AM (2012) Modern technologies in arthroplasty of the anterior cruciate ligament. Zemsky Vrach 2:21–23 (in Russian)Google Scholar
  4. 4.
    Davarinos N, O'Neill BJ, Curtin W (2014) A brief history of anterior cruciate ligament reconstruction. Adv Orthop Surg 706042.  https://doi.org/10.1155/2014/706042
  5. 5.
    Xie X, Liu X, Chen Z, Yu Y, Peng S, Li Q (2015) A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. Knee 22(2):100–110.  https://doi.org/10.1016/j.knee.2014.11.014 CrossRefGoogle Scholar
  6. 6.
    Gudas R, Jurkonis R, Smailys A (2018) Comparison of return to pre-injury sport after 10 mm size bone-patellar tendon-bone (BPTB) versus 8 mm hamstring anterior cruciate ligament reconstruction: a retrospective study with a two-year follow-up. Med Sci Monit 24:987–996CrossRefGoogle Scholar
  7. 7.
    Brophy RH, Schmitz L, Wright RW et al (2012) Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the multicenter orthopaedic outcomes network (MOON) group. Am J Sports Med 40:2517–2522CrossRefGoogle Scholar
  8. 8.
    Mascarenhas R, Tranovich MJ, Kropf EJ et al (2012) Bone-patellar tendon-bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2-10 year follow-up. Knee Surg Sports Traumatol Arthrosc 20:1520–1527CrossRefGoogle Scholar
  9. 9.
    Ardern CL (2015) Anterior cruciate ligament reconstruction-not exactly a one-way ticket back to the preinjury level: a review of contextual factors affecting return to sport after surgery. Sports Health 7(3):224–230.  https://doi.org/10.1177/1941738115578131 CrossRefGoogle Scholar
  10. 10.
    Chambat P, Guier C, Sonnery-Cottet B, Fayard JM, Thaunat M (2013) The evolution of ACL reconstruction over the last fifty years. Int Orthop 37(2):181–186.  https://doi.org/10.1007/s00264-012-1759-3 CrossRefGoogle Scholar
  11. 11.
    Nedeff DD, Bach BR (2002) Arthroscopic anterior cruciate ligament reconstruction using patellar tendon autografts. Orthopedics 25:343–357 quiz 358-349Google Scholar
  12. 12.
    Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634.  https://doi.org/10.1177/0363546503261722 CrossRefGoogle Scholar
  13. 13.
    Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 20(4):767–777.  https://doi.org/10.1007/s00167-011-1860-y CrossRefGoogle Scholar
  14. 14.
    Goncharov EN, Koval OA, Krasnov HO, Mironov AN, Goncharov NG (2018) Topography-anatomycal characteristics of anterolateral ligament in knee joint. Traumatol Orthop Russ 24(1):88–95.  https://doi.org/10.21823/2311-2905-2018-24-1-88-95 (in Russian)CrossRefGoogle Scholar
  15. 15.
    Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2015) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 23(11):3186–3195.  https://doi.org/10.1007/s00167-014-3117-z CrossRefGoogle Scholar
  16. 16.
    Sonnery-Cottet B, Lutz C, Daggett M, Dalmay F, Freychet B, Niglis L, Imbert P (2016) The involvement of the anterolateral ligament in rotational control of the knee. Am J Sports Med 44(5):1209–1214.  https://doi.org/10.1177/0363546515625282 CrossRefGoogle Scholar
  17. 17.
    Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthrosc J Arthrosc Related Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 30(11):1475–1482.  https://doi.org/10.1016/j.arthro.2014.05.039
  18. 18.
    Smith JO, Yasen SK, Lord B, Wilson AJ (2015) Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee. Knee Surg Sports Traumatol Arthrosc 23(11):3151–3156.  https://doi.org/10.1007/s00167-015-3783-5 CrossRefGoogle Scholar
  19. 19.
    Wagih AM, Elguindy AM (2016) Percutaneous reconstruction of the anterolateral ligament of the knee with a polyester tape. Arthrosc Tech 5(4):691–697.  https://doi.org/10.1016/j.eats.2016.02.028 CrossRefGoogle Scholar
  20. 20.
    Chahla J, Menge TJ, Mitchell JJ, Dean CS, LaPrade RF (2016) Anterolateral ligament reconstruction technique: an anatomic-based approach. Arthrosc Tech 5(3):453–457.  https://doi.org/10.1016/j.eats.2016.01.032 CrossRefGoogle Scholar
  21. 21.
    Leiter JR, Gourlay R, McRae S, de Korompay N, MacDonald PB (2014) Long-term follow-up of ACL reconstruction with hamstring autograft. Knee Surg Sports Traumatol Arthrosc 22(5):1061–1069.  https://doi.org/10.1007/s00167-013-2466-3 Google Scholar
  22. 22.
    Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45(7):596–606.  https://doi.org/10.1136/bjsm.2010.076364 CrossRefGoogle Scholar
  23. 23.
    Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84-A(9):1560–1572CrossRefGoogle Scholar
  24. 24.
    Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE (2012) Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy 28:526–531CrossRefGoogle Scholar
  25. 25.
    Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT, Parker RD, Kaeding CC, Magnussen RA (2013) The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy 29(12):1948–1953.  https://doi.org/10.1016/j.arthro.2013.08.025 CrossRefGoogle Scholar
  26. 26.
    Van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH (2012) Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 40(4):800–807.  https://doi.org/10.1177/0363546511432545 CrossRefGoogle Scholar
  27. 27.
    Jonsson H, Riklund-Ahlström K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5-9 years after surgery. Acta Orthop Scand 75(5):594–599.  https://doi.org/10.1080/00016470410001484 CrossRefGoogle Scholar
  28. 28.
    Monaco E, Maestri B, Conteduca F, Mazza D, Iorio C, Ferretti A (2014) Extra-articular ACL reconstruction and pivot shift: in vivo dynamic evaluation with navigation. Am J Sports Med 42(7):1669–1674.  https://doi.org/10.1177/0363546514532336 CrossRefGoogle Scholar
  29. 29.
    Helito CP, Bonadio MB, Gobbi RG, da Mota E Albuquerque RF, Pécora JR, Camanho GL, Demange MK (2015) Combined intra- and extra-articular reconstruction of the anterior cruciate ligament: the reconstruction of the knee anterolateral ligament. Arthrosc Tech 4(3):239–244.  https://doi.org/10.1016/j.eats.2015.02.006 CrossRefGoogle Scholar
  30. 30.
    Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BH, Murphy CG, Claes S (2015) Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med 43(7):1598–1605.  https://doi.org/10.1177/0363546515571571 CrossRefGoogle Scholar
  31. 31.
    Sonnery-Cottet B, Saithna A, Cavalier M, Kajetanek C, Temponi EF, Daggett M, Helito CP, Thaunat M (2017) Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI study group. Am J Sports Med 45(7):1547–1557.  https://doi.org/10.1177/0363546516686057 CrossRefGoogle Scholar
  32. 32.
    Ibrahim SA, Shohdy EM, Marwan Y, Ramadan SA, Almisfer AK, Mohammad MW, Abdulsattar WS, Khirat S (2017) Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: a randomized clinical trial. Am J Sports Med 45(7):1558–1566.  https://doi.org/10.1177/0363546517691517 CrossRefGoogle Scholar
  33. 33.
    Mogos S, Sendrea B, Stoica IC (2017) Combined anatomic anterior cruciate ligament and anterolateral ligament reconstruction. Maedica (Buchar) 12(1):30–35Google Scholar
  34. 34.
    Ardern CL, Taylor NF, Feller JA, Webster KE (2013) A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med 47(17):1120–1126.  https://doi.org/10.1136/bjsports-2012-091203 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Evgeniy Nikolaevich Goncharov
    • 1
    • 2
  • Oleg Aleksandrovich Koval
    • 2
    Email author
  • Vadim Erikovich Dubrov
    • 3
  • Eduard Nikolaevich Bezuglov
    • 4
  • Anastasiya Mikhaylovna Filimonova
    • 2
    • 5
  • Nikolay Gavriilovich Goncharov
    • 1
    • 2
  1. 1.Russian Medical Academy of Continuous Professional EducationMoscowRussia
  2. 2.Traumatology and Orthopedics CenterCentral Clinical Hospital of the Russian Academy of SciencesMoscowRussia
  3. 3.Department of the Fundamental Medicine FacultyLomonosov Moscow State UniversityMoscowRussia
  4. 4.Department of Sport MedicineI.M. Sechenov First Moscow State Medical UniversityMoscowRussia
  5. 5.Radiology Unit of Diagnostocal CenterCentral Clinical Hospital of the Russian Academy of SciencesMoscowRussia

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