Biomechanical comparison of anterolateral ligament anatomical reconstruction with a semi-anatomical lateral extra-articular tenodesis. A cadaveric study

Background: To compare the biomechanical behavior of an anterolateral ligament (ALL) anatomical reconstruction and a semianatomical lateral extra-articular tenodesis (LET) in the context of an anterior cruciate ligament (ACL) reconstruction combined with an anterolateral lesion. Methods: Twelve cadaveric knees were studied using a testing machine to assess the internal tibial rotation and anterior tibial translation across six surgical states: intact knee, ACL lesion, ACL + ALL lesion, ACL isolated reconstruction, ACL + ALL anatomical reconstruction and ACL + LET procedure. ALL and LET grafts were fixed at full knee extension and neutral rotation. Results: Presented with combined ACL and ALL lesions, isolated ACL reconstruction failed to restore the internal tibial rotation to intact-knee values (P> 0.05 for all angles). The addition of both an ALL reconstruction and LET procedure significantly reduced the internal rotation, restoring the rotation laxity to intact-knee values at 0 degrees and 30 degrees of flexion (P < 0.05) and with a certain level of overconstraint at 60 degrees and 90 degrees (mean 3 degrees +/- 2SD). A higher tendency to overconstraint was observed with the LET, but there was no significant difference when comparing the ALL reconstruction with the LET (P > 0.05 for all angles). Conclusions: Residual rotational laxity was found after isolated ACL reconstruction in the presence of an anterolateral lesion. The combination of ACL reconstruction with anatomical ALL reconstruction or the LET procedure resulted in restoration to intact-knee values but with a certain degree of overconstraint in higher flexion angles. Both techniques showed optimal biomechanical results with no data supporting the advantage of one over the other. (C) 2019 Elsevier B.V. All rights reserved.