This prospective matched-cohort study from the SANTI Study Group asked whether the protective effect of adding anterolateral ligament reconstruction (ALLR) to ACLR holds up at nearly 9 years. 86 propensity-matched pairs (combined ACL+ALLR vs isolated ACLR) were followed for a mean of 104 months. It is the first comparative long-term outcome study for anatomic ALLR.
The concern with adding any lateral extra-articular procedure has always been: does it cause overconstraint, stiffness, and lateral compartment arthritis? That fear, rooted in the Lemaire and MacIntosh era, caused LEAPs to be abandoned for decades.
This paper answers that concern directly for anatomic ALLR: at nearly 9 years, there were zero stiffness complications and no increase in any complication category. The safety profile is clean.
For a young patient with grade 3 pivot shift, chronic ACL injury, ligamentous hyperlaxity, or participation in pivoting contact sports, this data supports a concrete conversation: isolated ACLR carries a 17.4% rupture rate at 9 years vs 3.5% with combined reconstruction.
The number needed to treat to prevent one graft rupture is approximately 7. That is a compelling argument to add ALLR in high-risk patients, and activity level alone should not drive you away from it — the OR for rupture with isolated ACLR holds regardless of preinjury Tegner score.
One limitation to flag: osteoarthritis rates were not assessed radiographically at final follow-up, so the long-term cartilage story remains incomplete.
This prospective matched-cohort study from the SANTI Study Group asked whether the protective effect of adding anterolateral ligament reconstruction (ALLR) to ACLR holds up at nearly 9 years. 86 propensity-matched pairs (combined ACL+ALLR vs isolated ACLR) were followed for a mean of 104 months. It is the first comparative long-term outcome study for anatomic ALLR.
The concern with adding any lateral extra-articular procedure has always been: does it cause overconstraint, stiffness, and lateral compartment arthritis? That fear, rooted in the Lemaire and MacIntosh era, caused LEAPs to be abandoned for decades.
This paper answers that concern directly for anatomic ALLR: at nearly 9 years, there were zero stiffness complications and no increase in any complication category. The safety profile is clean.
For a young patient with grade 3 pivot shift, chronic ACL injury, ligamentous hyperlaxity, or participation in pivoting contact sports, this data supports a concrete conversation: isolated ACLR carries a 17.4% rupture rate at 9 years vs 3.5% with combined reconstruction.
The number needed to treat to prevent one graft rupture is approximately 7. That is a compelling argument to add ALLR in high-risk patients, and activity level alone should not drive you away from it — the OR for rupture with isolated ACLR holds regardless of preinjury Tegner score.
One limitation to flag: osteoarthritis rates were not assessed radiographically at final follow-up, so the long-term cartilage story remains incomplete.