Arthroscopic ACL reconstruction with extra-articular anterolateral augmentation

Main Article Content

Emad Gaber Elbanna
Ayman Abdolbaset Abdolsamad
Mohamed Ahmed Abd elkader
Hani Shehata Mahmoud Hamdallah


ACL reconstruction, anteroaletral ligament ,augmentation, pivot shift, rotational instability


Background: many techniques developed to overcome internal rotation instability associated with some cases of ACL injury , like changing techniques of tunneling from transtibial to more anatomical techniques, then double bundle reconstruction, recently the concept of adding the anterolateral reconstruction has been developed .
Purpose: to evaluate the knee functional outcome following combined ACL and ALL reconstruction using central strip of the iliotibial band for ALL reconstruction.
Study Design: case series
Methods: From October 2020 to July 2021, 30 patients with ACL tear associated with high grade pivoting underwent combined ACL and ALL reconstruction. Hamstring graft was used for the ACL that was fixed by adjustable loop on the femoral side and biodegradable interference screw on the tibial side and iliotibial band slip used for the ALL reconstruction. The follow up on regular basis for one year postoperative for the last case.
Results: the IKDC objective score was markedly improved from D in all case prop. to A to B with special concern to (Lachman test, anterior drawer test and the pivot shift test), IKDC subjective form mean score improved from 27.5 pre op. to 85 ,the lyshlom score pre operative was poor for all cases that improved to excellent to good.
Conclusion: It was found that this technique provide good reasonable solution for the internal rotation instability that is found in those patients with high grade pivot shift , with simple technique , easy learning curve, short time, good functional results

Abstract 112 | PDF Downloads 100


1 Stergiou N, Ristanis S, Moraiti C, Georgoulis AD. Tibial rotation in anterior cruciate ligament (ACL)-deficient and ACL-reconstructed knees. Sports medicine. 2007;37(7):601-13 .
2 Petersen W, Forkel P, Achtnich A, Metzlaff S, Zantop T. Anatomic reconstruction of the anterior cruciate ligament in single bundle technique. Operative Orthopadie und Traumatologie. 2013;25(2):185-204 .
3 Muneta T, Sekiya I, Yagishita K, Ogiuchi T, Yamamoto H, Shinomiya K. Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1999;15(6):618-24 .
4 Schreiber VM, van Eck CF, Fu FH. Anatomic double-bundle ACL reconstruction .Sports medicine and arthroscopy review. 2010;18(1):27-32 .
5 Vieira ELC, Vieira EÁ, Da Silva RT, dos Santos Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23(3 :) 269 - 74 .
6 Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. Journal of anatomy. 2013;223(4):321-8 .
7 Dodds A, Halewood C, Gupte C, Williams A, Amis A. The anterolateral ligament: anatomy ,length changes and association with the Segond fracture. The bone & joint journal. 2014;96(3):325-31 .
8 Zarins B, Rowe CR. Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract. JBJS. 1986;68(2):160-77 .
9 Marcacci M, Zaffagnini S, Giordano G, Iacono F, Lo Presti M. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10-to 13-year follow-up. The American journal of sports medicine. 2009;37(4):707-14 .
10 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. The American journal of sports medicine. 1982;10(3):150-4 .
11 Hefti F, Muller W. akob RP, Staubli HU .E aluation of knee ligament in uries with the IKDC form. 1993;1(3-4):226-34 .
12 Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ, Committee IKD. The International Knee Documentation Committee subjective knee evaluation form: normative data. The American journal of sports medicine. 2006;34(1):128-35 .
13 Puzzitiello RN, Agarwalla A, Bush-Joseph CA, Forsythe B. Iliotibial band tenodesis with a tenodesis screw for augmentation of anterior cruciate ligament reconstruction. Arthroscopy techniques. 2019 ; 8 ( 4 :) e389-e93.
14 Shaikh H, Herbst E, Rahnemai-Azar AA, Bottene Villa Albers M, Naendrup J-H, Musahl V, et al. The Segond fracture is an avulsion of the anterolateral complex. The American Journal of Sports Medicine. 2017;45(10):2247-52 .
15 Chahla J, Menge TJ, Mitchell JJ, Dean CS, LaPrade RF. Anterolateral ligament reconstruction technique: an anatomic-based approach. Arthroscopy Techniques. 2016;5(3):e453-e7 .
16 Parsons EM, Gee AO, Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. The American journal of sports medicine. 2015;43(3):669-74 .
17 Kittl C, Halewood C, Stephen JM, Gupte CM, Weiler A, Williams A, et al. Length change patterns in the lateral extra-articular structures of the knee and related reconstructions. The American journal of sports medicine. 2015;43(2):354-62 .
18 Kennedy MI, Claes S, Fuso FAF, Williams BT, Goldsmith MT, Turnbull TL, et al. The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. The American journal of sports medicine. 2015;43(7):1606-15 .
19 Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BH, Murphy CG, Claes S. Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up .The American Journal of Sports Medicine. 2015;43(7):1598-605 .
20 Sonnery-Cottet B, Saithna A, Cavalier M, Kajetanek C, Temponi EF, Daggett M, et al. 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. The American journal of sports medicine. 2017;45(7):1547-57 .
21 Porter M, Shadbolt B. Modified iliotibial band tenodesis is indicated to correct intraoperative residual pivot shift after anterior cruciate ligament reconstruction using an autologous hamstring tendon graft: a prospective randomized controlled trial. The American Journal of Sports Medicine. 2020;48(5):1069-77.