A new technique for combined anterior cruciate and anterolateral ligament reconstruction using quadriceps and plantaris tendons

Abstract

Anterior cruciate ligament (ACL) reconstructions with quadriceps tendon (QT) grafts are gaining popularity, both in primary and revision procedures. Recently, the role of the anterolateral ligament (ALL) of the knee in improving rotational knee stability has been emphasised and concurrent ACL and ALL reconstruction is advocated. In this paper, a new technique utilising the QT and the plantaris tendon (PLT) for combined ACL and ALL reconstruction is analysed. Patients that underwent combined ACL and ALL reconstruction using QT and PLT grafts in a 3-years period were prospectively analysed. A total of 9 patients with 6 months minimum follow-up were assessed with Lachman and Pivot shift clinical tests, International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner activity scale. One patient had reconstructed ACL re-rupture at the final follow-up visit, leaving 8 patients with a mean follow-up of 19±8 months. There was a significant improvement in anteroposterior and rotational stability in all the patients. The IKDC, KOOS, and Lysholm scores improved as well. The Tegner activity scale increased postoperatively, however, it did not reach preinjury values. QT and PLT grafts are valuable alternatives for currently used grafts in combined ACL and ALL reconstructive procedures. This new technique is a reasonable option in ACL revision surgery and a good alternative in primary ACL and ALL reconstruction, especially when hamstring grafts are not advised or they are missing.

Keywords

• Anterior cruciate ligament
• Anterolateral ligament
• Quadriceps tendon
• Plantaris tendon