How an Anterolateral Ligament Injury is Associated with ACL Tears
It is estimated between 5-15% of patients still have some level of instability after sustaining and correcting an ACL tear with an ACL reconstruction procedure.
In certain patients, rupture of the ALL along with the ACL may cause excess joint laxity that may not be resolved with just an ACL reconstruction. Many orthopedic surgeons now believe when the knee undergoes a significant injury and the ACL tears, the ALL often tears with it, resulting in greater abnormalities in rotational stability of the knee. Traditional ACL reconstructive surgery is not uniformly successful in treating knee pain and instability in all patients. Tunnel positioning, the graft selected and the rehabilitation all play a role and Dr. Getelman has published an important article regarding Failed ACL surgery. (Read Dr. Getelman’s JAAOS Article: Failure of Anterior Cruciate Ligament Reconstruction)
Other structures around the knee, such as the MCL and posterolateral corner structures, have been well studied and reported to have a rather significant role in providing knee stability and protecting an ACL reconstruction. If the patient has ongoing instability after an ACL reconstruction with an intact MCL and posterolateral corner and the ALL knee ligament is also torn, this may be one of the contributing factors and reasons why primary surgery has failed. Further research needs to be performed to determine if this is true, if the anterolateral ligament needs to be reconstructed after an injury and if an anterolateral ligament reconstruction will help protect revision ACL reconstruction.
We can now offer patients the possibility of reconstruction of the anterolateral ligament while performing an ACL reconstruction. Surgeons are able to perform this complex reconstruction with an understanding that this may result in a more stable knee joint in some patients.
For more information on the ALL knee ligament, or for additional information on an anterolateral ligament injury and knee pain, please contact the orthopedic office of Dr. Mark Getelman, knee specialist in the Van Nuys, Thousand Oaks and Los Angeles, California area.