Anterior Cruciate Ligament Revision Surgery: Patellar Tendon Graft with or without Anterolateral Ligament Reconstruction?
Authors: Pellegrino Marco , Bandinelli Diletta , Trinchese Alessandro Ninì , Cenci Giulia , Trinchese Ermanno 
Published: December 2023

INTRODUCTION
The Anterior cruciate Ligament Reconstruction (ACLR) is a recurrent successfully surgery, however the literature shows from 3 to 15% of failure. Many recurrent ACL roptures are due to technical surgical mistakes, however, even when the neo-ligament is correctly located and well tensioned, a high rate of partial anterolateral rotatory instability can be clinically detected in those patients.
We hypothesized that a recurrent ACL injury would often be associated with antero-lateral ligament lesion and so with an high grade pivoting.
The purpose of our retrospective study is to demonstrate if, in the recurrent ACLR surgery, the Anterolateral ligament reconstruction (ALLR) is necessary due to restore a correct rotatory stability of the knee, to improve clinical outcomes and to determine a better return to sport activities.

METHODS
We included a total of 63 patients undergone to ACLR after a LCA recurrent lesion from January 2018 to January 2020 performed by the same surgeon. The pooled data passed through exclusion criteria and we created two different groups: group A with 11 patients (whom undergone to ACLR with bone-patellar-tendon-bone autograft) and group B with 12 patients (whom undergone to ACLR with bone-patellar-tendon-bone autograft + ALLR).

A single operator (different from the surgeon) has clinically evaluated the patients with a 18.75 +/- 8.27 month follow-up.
LYSHOLM score, IKDC and ACL-RSI scale clinical questionnaires were used to subjectively evaluation. Pivot-shift test and Rolimeter (Aircast Europa) arthrometric evaluation were used for an objective evaluation.
All patients have done a knee XR due to confirm the correct bone tunnels direction.
All data were meta-analyzed with the IBM-SPSS software (for MAC, version 22.0) and the results were published as media +/- standard deviation or Standard Error or percentage prevalence, when appropriate.
To compare all the clinicals and scores data, we used T-Test for same data, Chi-Square for the percentage data. P-values under 0,05 were considered as significant.

RESULTS
Our study shows as in the recurrent ACLR surgery, the associated ACLR+ALLR is totally necessary and complementary due to statistically significantly reduction of the remaining anterolateral rotatory instability (p-value under 0.05)

CONCLUSION
Looking at the recent literature and the preliminary results of this study, the anatomical ALL reconstruction associated with the ACLR, should have been chosen as a better surgery practice in the revision surgery due to reduce anterolateral rotatory instability and the percentage of failure, to increase the odds of graft integrations, the clinical outcomes and the percentage of the return to the same level of sports.
The indication of this surgery practice should have been custom-made, because it is mandatory to consider the functional necessary levels for the patient and because the rehabilitation needs time, dedication and commitment to achieve the best clinical and functional results.