Anterolateral Ligament Reconstruction in Addition to Primary Double-bundle Anterior Cruciate Ligament Reconstruction for Grade 3 Pivot Shift Improves Residual Knee Instability During Surgery

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2021 Jul 19

PMID 34278532

Citations 5

Authors

Yusuke Kawanishi

Makoto Kobayashi

Sanshiro Yasuma

Hiroaki Fukushima

Jiro Kato

Atsunori Murase

Tetsuya Takenaga

Masahito Yoshida

Gen Kuroyanagi

Yohei Kawaguchi

Yuko Nagaya

Hideki Murakami

Masahiro Nozaki

Affiliations

Soon will be listed here.

Abstract

Purpose: High-grade pivot shift in the anterior cruciate ligament (ACL) injured knee is a risk factor for postoperative residual pivot shift. Procedures in addition to ACL reconstruction such as anterolateral ligament (ALL) reconstruction have been performed for patients with a high-risk of residual pivot shift. The aim of this study was to investigate the effect of the addition of ALL reconstruction to primary double-bundle ACL reconstruction in patients with preoperative high-grade pivot shift to improve stability as evaluated by quantitative measurement.

Methods: Patients with ACL injuries who showed preoperative grade 3 subjective pivot shift and who underwent primary double-bundle ACL reconstruction combined with ALL reconstructions were retrospectively enrolled. Anterior tibial translation (ATT) in the Lachman test, and acceleration and external rotational angular velocity (ERAV) in the pivot shift were measured as quantitative values. Quantitative values before surgical intervention for ACL-injured knees (ACLD) and uninjured contralateral knees (intact), after temporary fixation of the isolated ACL grafts (ACLR), and subsequently after temporary fixation of both ACL and ALL grafts (ACLR + ALLR) were measured with the patient under general anaesthesia.

Results: In total, 18 patients were included. The ATT was lower in ACLR and ACLR + ALLR than in intact (P = .008 and .005), while there was no significant difference between ACLR and ACLR + ALLR (P > .05). The acceleration of ACLR + ALLR was lower than that for ACLR (P = .008), while there was no significant difference between intact and ACLR or ACLR + ALLR (P > .05). The ERAV of ACLR was higher than that of intact (P < .001), while that of ACLR + ALLR was lower than that of ACLR (P < 0.001), and there was no significant difference in ERAV between intact and ACLR + ALLR (P > 0.05).

Conclusion: According to quantitative assessment of the pivot shift, the addition of ALL reconstruction to primary double-bundle ACL reconstruction improved residual knee instability and restored knee stability during surgery. Combination of ALL reconstruction with primary double-bundle ACL reconstruction was effective for patients with ACL injuries exhibiting a preoperative grade 3 subjective pivot shift.

Level Of Evidence: IV.

Citing Articles

Anterior Cruciate Ligament Reconstruction in Young Athletes: A Comprehensive Review of Lateral Extra-Articular Tenodesis and Anterolateral Ligament Reconstruction Techniques.

Patil B, Goyal S, Salwan A, Singh R Cureus. 2024; 16(9):e70333.

PMID: 39469369 PMC: 11513215. DOI: 10.7759/cureus.70333.

Does lateral extra-articular tenodesis affect knee stability in cases with isolated anterior cruciate ligament reconstruction?.

Nabil A, Abd Halim Hafez K, Rizk A, Abu Taleb A, Emad R J Orthop. 2024; 53:7-12.

PMID: 38450063 PMC: 10912222. DOI: 10.1016/j.jor.2024.02.015.

Factors Associated With Residual Pivot Shift After ACL Reconstruction: A Quantitative Evaluation of the Pivot-Shift Test Preoperatively and at Minimum 12-Month Follow-up.

Kawanishi Y, Kobayashi M, Yasuma S, Fukushima H, Kato J, Murase A Orthop J Sports Med. 2024; 12(2):23259671241230967.

PMID: 38414663 PMC: 10898316. DOI: 10.1177/23259671241230967.

Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome.

Pontoh L, Dilogo I, Kamal A, Widodo W, Kholinne E, Rhatomy S Eur J Orthop Surg Traumatol. 2022; 33(3):489-495.

PMID: 36474084 DOI: 10.1007/s00590-022-03432-7.

Preoperative quantitative pivot shift does not correlate with in vivo kinematics following ACL reconstruction with or without lateral extraarticular tenodesis.

Gibbs C, Hughes J, Popchak A, Chiba D, Winkler P, Lesniak B Knee Surg Sports Traumatol Arthrosc. 2022; 31(7):2802-2809.

PMID: 36394585 DOI: 10.1007/s00167-022-07232-8.

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