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.