Modified Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction in 291 High-Level Athletes: Clinical Outcomes at Minimum 2.5-Year Follow-Up

• Published in: Medicina
• Main Authors: Tomislav Kottek, Stjepan Bulat, Goran Vrgoč, Alan Ivković, Frane Bukvić, Joško Jeličić, Saša Janković
• Format: Article
• Language: English
• Published: MDPI AG 2025-09-01
• Subjects: anterior cruciate ligament; anterolateral ligament; anterior cruciate ligament reconstruction; athletes; return to sport
• Online Access: https://www.mdpi.com/1648-9144/61/10/1762
• ISSN: 1010-660X; 1648-9144

<i>Background and Objectives</i>: Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has been advocated to improve rotational stability and reduce graft failure in high-risk athletes. We aimed to evaluate the mid-term functional outcomes of a modified combined ACL and ALL reconstruction technique using hamstring tendon autografts developed at our institution. <i>Materials and Methods</i>: We retrospectively reviewed 395 patients who underwent combined ACL and ALL reconstruction between 2018 and 2022. Of these, 291 patients (73.6%) completed the minimum follow-up of 2.5 years and were included in the analysis. Primary outcomes were graft rerupture and return to sport (RTS) at the pre-injury level. Secondary outcomes included graft survival, a change in Tegner score from pre-injury to follow-up and complications. <i>Results</i>: The cohort consisted of 219 males (75.3%) and 72 females (24.7%), with a mean age of 20.6 ± 4.0 years (range 14–35). Eleven patients experienced graft rerupture, yielding a rate of 3.78% (95% CI, 2.1–6.6). At final follow-up, 220 patients (75.6%; 95% CI, 70.4–80.2) returned to their pre-injury level of sport performance. The mean Tegner activity score decreased from 7.9 ± 1.4 preoperatively to 7.2 ± 1.8 postoperatively (paired <i>t</i>-test, <i>p</i> < 0.0001; Wilcoxon signed-rank test, <i>p</i> < 0.0001). Postoperative complications occurred in 18 patients (6.2%), the majority of which related to meniscal re-ruptures. <i>Conclusions</i>: Our modified combined ACL and ALL reconstruction technique demonstrated excellent mid-term results in a high-risk athletic population, with low rerupture rates and high RTS rates, while also being a safe procedure without significant complications. These findings support the use of this technique in young and professional athletes where rotational stability is necessary.