Anterolateral Ligament Reconstruction Combined with Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes

Background and Objectives: The anterior cruciate ligament (ACL) is crucial for knee stability, preventing anterior displacement of the tibia and rotation relative to the femur. Despite ACL reconstruction (ACLR), residual instability is common, affecting knee function. Anterolateral ligament reconstruction (ALLR) alongside ACLR improves outcomes, as the ALL plays a significant role in rotational stability. This study aims to assess the clinical and functional outcomes of the ACLR+ALLR combination using biomechanical testing in patients with at least ten months of follow-up. Materials and Methods: This cross-sectional comparative cohort study involves patients with ACLR. Inclusion criteria were adult patients who underwent ACLR within the last 3 years, with the same surgical technique performed by a single operator. Patients underwent anamnestic and clinical evaluation and completed Lysholm and KOOS questionnaires. Biomechanical tests included a Unilateral Drop Jump, a Countermovement Jump with knee rotation, and a five-repetition Sit-To-Stand. Force platforms, a camera, and surface electromyography were used to assess biomechanical stability and joint function. Results: This study included 18 subjects, 5 with ACLR and ALLR, and 13 with ACLR alone. The groups showed no significant differences in the KOOS and Lysholm scales and clinical outcomes. Muscle trophism reduction compared to the contralateral limb was noted in both groups. Biomechanical evaluations showed no difference in Quadriceps muscle activity during the landing phase of the Drop Jump. However, the ACL-ALL group exhibited fewer spikes and fewer knee joint angular excursions during ground impact stabilization. In the 5-STS task, a significant difference was observed in the vertical force peak. Differences in muscle activity during foot rotation and force components during the jumping phase were noted in the Countermovement Jump. Conclusions: ACLR combined with ALLR shows similar perceived joint function but improved biomechanical joint stability. Further studies with larger samples and longer follow-ups are needed for validation.