This Level 4 case series reports the first outcomes data for combined ACL and anterolateral ligament (ALL) reconstruction. Ninety-two patients with high-risk features for rotational instability underwent the combined procedure, with 83 available at mean 32-month follow-up. The study asks whether adding an anatomic ALL reconstruction improves rotational control without adding complications.
Before this paper, persistent rotational instability (positive pivot shift) after ACL reconstruction was a known problem affecting up to 25% of patients, and historical attempts at extra-articular tenodesis had been abandoned due to stiffness and poor outcomes with older techniques.
This paper established that a minimally invasive, anatomically-guided ALL reconstruction — using the gracilis tendon fixed in neutral rotation at the isometric femoral point. Could eliminate the pivot shift in over 90% of patients without causing the complications that plagued earlier lateral tenodesis procedures.
When you see a young athlete in pivoting sport, a grade 3 pivot shift on exam, a Segond fracture on X-ray, or a lateral femoral notch sign, this paper is the evidence base for why you should consider adding an ALL reconstruction to your ACL procedure.
The ALL tibial footprint is the site of the Segond fracture. Halfway between Gerdy's tubercle and the fibular head. A high-yield anatomic landmark for both boards and surgical planning.
This Level 4 case series reports the first outcomes data for combined ACL and anterolateral ligament (ALL) reconstruction. Ninety-two patients with high-risk features for rotational instability underwent the combined procedure, with 83 available at mean 32-month follow-up. The study asks whether adding an anatomic ALL reconstruction improves rotational control without adding complications.
Before this paper, persistent rotational instability (positive pivot shift) after ACL reconstruction was a known problem affecting up to 25% of patients, and historical attempts at extra-articular tenodesis had been abandoned due to stiffness and poor outcomes with older techniques.
This paper established that a minimally invasive, anatomically-guided ALL reconstruction — using the gracilis tendon fixed in neutral rotation at the isometric femoral point. Could eliminate the pivot shift in over 90% of patients without causing the complications that plagued earlier lateral tenodesis procedures.
When you see a young athlete in pivoting sport, a grade 3 pivot shift on exam, a Segond fracture on X-ray, or a lateral femoral notch sign, this paper is the evidence base for why you should consider adding an ALL reconstruction to your ACL procedure.
The ALL tibial footprint is the site of the Segond fracture. Halfway between Gerdy's tubercle and the fibular head. A high-yield anatomic landmark for both boards and surgical planning.