Description
Objective
Anterior cruciate ligament (ACL) rupture is a relatively common lesion. When the reconstruction fails, it can result in a highly disabling condition, and understanding the reasons behind this failure is not always straightforward. Hence, there has been a growing interest in performing anterolateral ligament reconstruction associated with ACL reconstruction in an effort to reduce rotatory instability. One of the theoretical disadvantages of this procedure is the increased overload in the external compartment and higher risk of stiffness.
The aim of our study was to compare, functionally and biomechanically, the healthy knee with the treated one, which had an ACL and ALL reconstruction. To our knowledge, there are no similar studies available.
Matherials
An observational study was carried out. We designed a protocol where we set out to compare both knees: the untreated and the intervened one. All patients were operated by the same surgeon between 2020 and 2022, with a minimum one-year follow-up.
We assessed knee range of motion, coronal balance, and the rotational angle of the tibia relative to the femur in different activities, such as straight-line walking, running, and going up and down stairs, through Xsens® motion sensors. As anatomical reference, 0º was defined as looking straight ahead with the limbs normoaligned and fully extended. We set out to do a purely descriptive analysis. Functional evaluation was performed through KOOS and IKDC scores.
Results
We performed an analysis of 20 patients. The mean age was 28 years and the sample was mainly composed of men.
In our analysis, we observed that the range of articular motion between joints was similar
Concerning straight-line walking, we observed that the normal knee presented with a discrete hyperextension (0,15º VS -2,07º). The intervened knee, in median, was capable of more addution (-10,79 VS -1,02). The rotation of the limb was equal between knees.
Regarding running, the operated leg had a slightly higher addution (-1,57º VS -0,87º), compared with the other. There was a discrete tendency to have the leg externally rotated and it discreetly diminished in the knee with ALL (-0,05º VS -0,25º).
Relatively going up and down stairs, both knees presented, in median, in addution, but the operated one with a slightly higher angle (-2,36º VS -0,55º). In regard to rotation, the normal had more internal rotation (0,14º) and the intervened external (-0,23º).
The mean KOOS and IKDC score was 95.
Conclusions
According to our paper, we can affirm we had good clinical results. The ALL-concomitant reconstruction seems to lead to higher values of adduction, between the femur and tibia, which translates into a more varus orientation of the limb. More robust studies are needed.
The results of this paper reinforce the importance of strict collaboration between medicine and engineering, namely, in orthopedics so that we can evaluate in more detail the results obtained from a more global perspective and not a purely mechanical one.
