Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes

<i>Background and Objectives</i>: The anterior cruciate ligament (ACL) is crucial for knee stability, preventing anterior displacement of the tibia and rotation relative to the femur. Despite ACL reconstruction (ACLR), residual instability is common, affecting knee function. Anterolatera...

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Main Authors: Giuseppe Danilo Cassano, Lorenzo Moretti, Michele Coviello, Ilaria Bortone, Mariapia Musci, Ennio Favilla, Giuseppe Solarino
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Medicina
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Online Access:https://www.mdpi.com/1648-9144/61/6/1011
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author Giuseppe Danilo Cassano
Lorenzo Moretti
Michele Coviello
Ilaria Bortone
Mariapia Musci
Ennio Favilla
Giuseppe Solarino
author_facet Giuseppe Danilo Cassano
Lorenzo Moretti
Michele Coviello
Ilaria Bortone
Mariapia Musci
Ennio Favilla
Giuseppe Solarino
author_sort Giuseppe Danilo Cassano
collection DOAJ
description <i>Background and Objectives</i>: The anterior cruciate ligament (ACL) is crucial for knee stability, preventing anterior displacement of the tibia and rotation relative to the femur. Despite ACL reconstruction (ACLR), residual instability is common, affecting knee function. Anterolateral ligament reconstruction (ALLR) alongside ACLR improves outcomes, as the ALL plays a significant role in rotational stability. This study aims to assess the clinical and functional outcomes of the ACLR+ALLR combination using biomechanical testing in patients with at least ten months of follow-up. <i>Materials and Methods:</i> This cross-sectional comparative cohort study involves patients with ACLR. Inclusion criteria were adult patients who underwent ACLR within the last 3 years, with the same surgical technique performed by a single operator. Patients underwent anamnestic and clinical evaluation and completed Lysholm and KOOS questionnaires. Biomechanical tests included a Unilateral Drop Jump, a Countermovement Jump with knee rotation, and a five-repetition Sit-To-Stand. Force platforms, a camera, and surface electromyography were used to assess biomechanical stability and joint function. <i>Results:</i> This study included 18 subjects, 5 with ACLR and ALLR, and 13 with ACLR alone. The groups showed no significant differences in the KOOS and Lysholm scales and clinical outcomes. Muscle trophism reduction compared to the contralateral limb was noted in both groups. Biomechanical evaluations showed no difference in Quadriceps muscle activity during the landing phase of the Drop Jump. However, the ACL-ALL group exhibited fewer spikes and fewer knee joint angular excursions during ground impact stabilization. In the 5-STS task, a significant difference was observed in the vertical force peak. Differences in muscle activity during foot rotation and force components during the jumping phase were noted in the Countermovement Jump. <i>Conclusions:</i> ACLR combined with ALLR shows similar perceived joint function but improved biomechanical joint stability. Further studies with larger samples and longer follow-ups are needed for validation.
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spelling doaj-art-ad66e798697c436c8ad26396bc6eddff2025-08-20T03:27:33ZengMDPI AGMedicina1010-660X1648-91442025-05-01616101110.3390/medicina61061011Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional OutcomesGiuseppe Danilo Cassano0Lorenzo Moretti1Michele Coviello2Ilaria Bortone3Mariapia Musci4Ennio Favilla5Giuseppe Solarino6Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyOrthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyOrthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, ItalyOrthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Mechanical Mathematics and Management (DMMM), Politecnico di Bari, 70126 Bari, ItalyOrthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyOrthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy<i>Background and Objectives</i>: The anterior cruciate ligament (ACL) is crucial for knee stability, preventing anterior displacement of the tibia and rotation relative to the femur. Despite ACL reconstruction (ACLR), residual instability is common, affecting knee function. Anterolateral ligament reconstruction (ALLR) alongside ACLR improves outcomes, as the ALL plays a significant role in rotational stability. This study aims to assess the clinical and functional outcomes of the ACLR+ALLR combination using biomechanical testing in patients with at least ten months of follow-up. <i>Materials and Methods:</i> This cross-sectional comparative cohort study involves patients with ACLR. Inclusion criteria were adult patients who underwent ACLR within the last 3 years, with the same surgical technique performed by a single operator. Patients underwent anamnestic and clinical evaluation and completed Lysholm and KOOS questionnaires. Biomechanical tests included a Unilateral Drop Jump, a Countermovement Jump with knee rotation, and a five-repetition Sit-To-Stand. Force platforms, a camera, and surface electromyography were used to assess biomechanical stability and joint function. <i>Results:</i> This study included 18 subjects, 5 with ACLR and ALLR, and 13 with ACLR alone. The groups showed no significant differences in the KOOS and Lysholm scales and clinical outcomes. Muscle trophism reduction compared to the contralateral limb was noted in both groups. Biomechanical evaluations showed no difference in Quadriceps muscle activity during the landing phase of the Drop Jump. However, the ACL-ALL group exhibited fewer spikes and fewer knee joint angular excursions during ground impact stabilization. In the 5-STS task, a significant difference was observed in the vertical force peak. Differences in muscle activity during foot rotation and force components during the jumping phase were noted in the Countermovement Jump. <i>Conclusions:</i> ACLR combined with ALLR shows similar perceived joint function but improved biomechanical joint stability. Further studies with larger samples and longer follow-ups are needed for validation.https://www.mdpi.com/1648-9144/61/6/1011anterior cruciate ligament reconstructionACLanterolateral ligament reconstructioncombined procedureALLclinical evaluation
spellingShingle Giuseppe Danilo Cassano
Lorenzo Moretti
Michele Coviello
Ilaria Bortone
Mariapia Musci
Ennio Favilla
Giuseppe Solarino
Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes
Medicina
anterior cruciate ligament reconstruction
ACL
anterolateral ligament reconstruction
combined procedure
ALL
clinical evaluation
title Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes
title_full Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes
title_fullStr Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes
title_full_unstemmed Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes
title_short Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes
title_sort anterolateral ligament reconstruction combined with anterior cruciate ligament reconstruction clinical and functional outcomes
topic anterior cruciate ligament reconstruction
ACL
anterolateral ligament reconstruction
combined procedure
ALL
clinical evaluation
url https://www.mdpi.com/1648-9144/61/6/1011
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