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This study evaluates whether the knee flexion angle used during fixation of the anterolateral ligament (ALL) affects clinical outcomes in patients undergoing combined anterior cruciate ligament (ACL) and ALL reconstruction.
Combined ACL and ALL reconstruction is increasingly used to improve rotational knee stability and reduce the risk of graft failure after ACL injury. However, the optimal knee position for fixing the ALL graft during surgery remains unclear. In this study, patients were treated with ALL fixation performed either in full knee extension (0 degrees) or at 30 degrees of knee flexion.
Clinical outcomes, knee stability, patient-reported function, and graft failure rates were compared between the two groups at a minimum follow-up of two years. Outcomes were assessed using validated questionnaires, clinical examinations, and objective measurements of knee stability.
The study aims to determine whether the knee flexion angle at the time of ALL fixation influences postoperative function, stability, or complication rates, and to provide clinical evidence to guide surgical technique in combined ACL and ALL reconstruction.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ALL Fixation at 0 Degrees of Knee Flexion | Active Comparator | Participants undergoing combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction in which the ALL graft is fixed with the knee in full extension (0 degrees) during surgery. |
|
| ALL Fixation at 30 Degrees of Knee Flexion | Active Comparator | Participants undergoing combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction in which the ALL graft is fixed with the knee flexed at 30 degrees during surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| anterolateral ligament reconstruction | Procedure | The intervention consists of a standardized combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction performed using anatomical single-bundle ACL reconstruction and anatomical ALL reconstruction. The surgical technique, graft selection, tunnel placement, fixation devices, and postoperative rehabilitation protocol are identical in both study arms. The only variable distinguishing the interventions is the knee flexion angle at the time of femoral fixation of the ALL graft. In one group, the ALL graft is tensioned and fixed with the knee in full extension (0 degrees). In the other group, the ALL graft is tensioned and fixed with the knee positioned at 30 degrees of flexion. No intraoperative measurements of graft tension are performed, and fixation is carried out according to a predefined standardized protocol. All procedures are performed by experienced surgeons using the same surgical landmarks for graft placement, with the intent of isolating the effect |
| Measure | Description | Time Frame |
|---|---|---|
| graft rerupture rate | Graft rerupture is defined as a failure of the reconstructed anterior cruciate ligament (ACL), diagnosed by clinical evidence of knee instability and confirmed by imaging findings consistent with graft discontinuity or revision surgery. | 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| anterior knee laxity | Anterior knee laxity will be assessed as the side-to-side difference (in millimeters) between the operated and contralateral knee using a Rolimeter arthrometer. | 24 months |
| pivot shift test |
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inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jacopo Conteduca, MD | Contact | 0039 3332280645 | CONTEDUCA85@GMAIL.COM |
| Name | Affiliation | Role |
|---|---|---|
| Jacopo Conteduca, MD | ASL Lecce | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34250171 | Background | Kelly SR, Cutter BM, Huish EG Jr. Biomechanical Effects of Combined Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021 Jun 24;9(6):23259671211009879. doi: 10.1177/23259671211009879. eCollection 2021 Jun. | |
| 34556187 | Background |
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Individual participant data will not be shared due to ethical and privacy considerations and the absence of a predefined data-sharing plan at the time of study design.
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|
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Rotational knee stability will be evaluated using the pivot shift test, graded according to standard clinical classification (grade 0 to 3) by an experienced examiner.
| 24 months |
| kinesiophobia | Fear of movement and reinjury will be assessed using the Tampa Scale for Kinesiophobia (TSK-11) questionnaire. range 11-44 | 24 months |
| subjective knee function | Patient-reported knee function will be assessed using the International Knee Documentation Committee (IKDC) subjective knee evaluation form. range 0-100 | 24 months |
| Ariel de Lima D, de Lima LL, de Souza NGR, de Moraes Perez RA, Sobrado MF, Guimaraes TM, Helito CP. Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis. Knee Surg Relat Res. 2021 Sep 23;33(1):33. doi: 10.1186/s43019-021-00115-1. |
| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| D054198 | Precursor Cell Lymphoblastic Leukemia-Lymphoma |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
| D007945 | Leukemia, Lymphoid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D001275 | ATP Citrate (pro-S)-Lyase |
| ID | Term |
|---|---|
| D000217 | Acyltransferases |
| D014166 | Transferases |
| D004798 | Enzymes |
| D045762 | Enzymes and Coenzymes |
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