Learning curve for combined reconstruction of the anterolateral and anterior cruciate ligaments: a report of 108 cases with a single surgeon.

Abstract

Background: Anterior cruciate ligament (ACL) rupture is a common lesion among young sports players, for whom isolated surgical repair remains the gold standard. However, there is a high risk of re-rupture after ACL reconstruction. Recent results of ACL reconstruction combined with reconstruction of the anterolateral ligament (ALL) have shown a significant decrease in this risk. However, as with all new techniques, this requires a learning curve.

Hypothesis: Combined reconstruction of the ACL and ALL would have a short learning curve, be reproducible and have no specific complications.

Patients and methods: This retrospective study included the first 108 patients who underwent combined ACL and ALL reconstruction by a single surgeon. The patients were divided into four similar sized chronological groups (groups 1-4). Tourniquet time and associated procedures were analysed. The results of the IKDC subjective knee evaluation, Lysholm, KOOS and SANE functional scores were collected postoperatively at 1-year through an online database. The position of the femoral tunnel was evaluated using the quadrant method of Bernard and Hertel.

Results: A significant improvement in the position of the femoral tunnel in the proximo-distal axis was observed between groups 1 and 4 (p < 0.01), as well as between groups 3 and 4 (p < 0.001). The Lysholm functional score was significantly higher in group 4 at 1-year (difference between groups 1 and 4 (+3.2 (1.4-5.1), p = 0.017)). The tourniquet time decreased significantly between the first group and groups 2, 3 and 4 (p < 0.002).

Discussion: Precise positioning of the femoral tunnel in the proximo-distal axis is important during combined reconstruction of the ACL and ALL. The combined technique had a rapid learning curve, was reproducible, and resulted in a rapid decrease in the tourniquet time.

Level of evidence: III; observational study.