For many years, Anterior Cruciate Ligament (ACL) reconstruction has been the gold standard for treating ACL tears. However, some patients, particularly those involved in high-demand, pivoting sports, continue to experience a feeling of persistent knee instability and rotational laxity after surgery. This groundbreaking article, published in Knee Surgery, Sports Traumatology, Arthroscopy, presents a solution to this problem by introducing a novel surgical technique that combines both ACL and Anterolateral Ligament (ALL) reconstruction.
A Minimally Invasive Dual-Ligament Approach
The presented technique focuses on anatomically reconstructing both the ACL and the ALL in a single, minimally invasive procedure. By using autologous semitendinosus and gracilis grafts, which are harvested from the patient’s own body, the surgical team can create a robust, dual-ligament construct. This method is specifically designed to be easily and efficiently integrated with existing all-inside ACL reconstruction techniques, meaning it requires minimal additional operative time, surgical equipment, or specialized expertise.
Enhancing Rotational Stability and Outcomes
The primary goal of this combined approach is to enhance rotational stability in the knee. While a standard ACL reconstruction primarily addresses front-to-back stability, the ALL plays a critical role in preventing excessive internal rotation of the tibia. By addressing both ligaments, this technique aims to restore the knee’s natural biomechanics more completely. The benefits of this approach are significant: it is designed to address the root cause of persistent instability and ultimately improve long-term patient outcomes, allowing individuals to return to their desired physical activities with greater confidence and a more stable knee.
Redefining ACL Reconstruction
This research highlights a new frontier in the management of knee injuries, particularly for high-risk patients. By offering an effective way to address both primary ACL insufficiency and the often-overlooked anterolateral ligament, this technique provides surgeons with a powerful new tool. The article serves as a valuable resource for guiding surgeons on how to achieve superior results by restoring the knee’s full rotational and translational stability.
Professor Wilson’s Comments
“This is one of my papers focusing on the combination of an ALL — that’s the anterolateral ligament — reconstruction with an ACL reconstruction. I’m very proud of this paper, as we were actually the first to carry out ALL surgery using a free graft.
In this publication, we described the technique in detail and highlighted the key innovation, which was to use the patient’s own hamstrings — one for the ACL reconstruction and the second for the ALL reconstruction. This approach was truly pioneering at the time.
The ALL functions almost like an ACL on the side of the knee, so in effect, you’re performing two ACL-type procedures to restore rotational stability. This concept of adding a lateral extra-articular tenodesis or ALL reconstruction alongside the ACL was something I was particularly proud of developing and implementing in the early to middle part of my career.”
For a comprehensive analysis of the full data and methodology, we encourage you to read the complete research paper.
Combined Anterolateral Ligament and Anatomic Anterior Cruciate Ligament Reconstruction of the Knee
