Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction

Abstract

Recently described in the medical literature, the anterolateral ligament of the knee is already considered an important stabilizer against the anterolateral tibial rotation, affecting the pivot shift in the failure of the anterior cruciate ligament and behaving as an important secondary rotational stabilizer. The mechanism of anterolateral ligament injury combined with anterior cruciate ligament injury is similar to the mechanism of anterior cruciate ligament injury alone. Thus, the main objective of the joint reconstruction of anterior cruciate ligament and anterolateral ligament would be increased rotational control and prevention of anterior cruciate ligament re-rupture. In view of this importance, the aim of the present study is to summarize the evidence on the main surgical indications described for anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis or anterolateral ligament reconstruction. A review of the literature was conducted in April 2017, through a search of the PubMed, MEDLINE, Cochrane, and Google Scholar databases, with no date limits. After reviewing the main articles in the subject, it was concluded that the main surgical indications described for anterior cruciate reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction are: anterior cruciate ligament revision, physical examination with pivotal shift grade 2 or 3, practice of sport with pivot mechanism and/or high level mechanism, ligament laxity and Segond fracture; Secondly, the following may also be indications: chronic anterior cruciate ligament injury, age less than 25 years old, and radiological sign of lateral femoral condyle depression. However, it is worth mentioning that more studies are still needed to prove these trends.