Presentation given by Dr Saithna at the 2019 AANA (Arthroscopy Association North America) Annual Meeting on the Outcomes of Combined ACL and anterolateral ligament reconstruction in Professional Athletes

1. Clinical Outcomes of Combined Anterior Cruciate
and Anterolateral Ligament Reconstruction in A
Series of Seventy Professional Athletes
Saithna A, Rosenstiel N, Praz C, Ouanezar H, Thaunat M, Sonnery-Cottet B
Dr Adnan Saithna
King James IV Professor, Royal College of Surgeons Edinburgh
Honorary Professor, Nottingham Trent University, UK
Adjunct Clinical Faculty, Kansas City University of Medicine and Biosciences
Sano Orthopedics, Kansas City, USA

2. Disclosures
Consultant for Arthrex. Consultancy for Smith & Nephew in the last 12 months
AANA research committee member and Arthroscopy Journal Editorial Board

3. • Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL
Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative
Study of 502 Patients From the SANTI Study Group.
– 2.5-3 fold reduction in ACL graft rupture rates when compared to isolated ACLR in a high
population (young patients, pivoting sports)
Winner of 2017 Richard J O’Connor Award

4. Surgical Technique
Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction.
Saithna et al . JBJS EST. 2018

5. “…as of now, the pudding is tasting pretty
darn good. Bon appétit.”

6. KARTUS HETTRICH ACL+ALL
Re-operation rate 26.7% 18.9% 13.1%
Meniscus 8.6% 5% 5.5%
Arthrofibrosis 10.7% 4.1% 4.0%
Deep Infection 0.9% 0.5% 0.5%

7. – Protects repaired medial meniscus: Two fold reduction in re-
operation for MM repair failure in patients with ACLR+ALLR
compared to patients with isolated ACLR (hazard ratio, 0.443;
95% CI, 0.218-0.866).

9. Almost 40% of respondents to AOSSM survey had performed LEAPs at the time of ACLR

10. Rugby
Basket
Ski
Others
Football
TYPE OF SPORTS
Combined ACL+ALL R in Pro
Athlete
• 70 Pro Athletes (BSC 2011-16)
• Mean FU : 3.9 years (2-7)

11. Meniscus Injury & Management
Meniscal Tear
Medial 32%
Lateral 45%
Meniscal Repair
Medial 86%
Lateral 94%
Meniscectomy
Medial 14%
Lateral 6%

12. Re-operations 15,7%
ACL revision n=4 (5.7%)
2nd Meniscectomy
Medial n=3 (4.3%)
Lateral n=1 (1.4%)
Others
Cyclops n=1 (1.4%)
Haemarthrosis n=1 (1.4%)
Deep Infection n=1 (1.4%)

13. All athletes n = 70
Return to professional level 85.7%
Return to Professional Sport
Mean delay 7.9 months (5 – 12)

14. Pre-Op Post-Op p
IKDC Subjective 56.1 +/-13.3 90.5 +/- 7.6 <0.001
Lysholm 48.4 +/-12.5 94.4 +/-7.5 <0.001
Pivot Shift (IKDC) <0.001
equal 66 (94.3%)
glide 16 (22.8%) 4 (5.7%)
clunk 23 (32.9%)
gross 31 (44.3%)
AP laxity 7.1 +/- 1.4mm 0.4 +/-0.9 <0.001

15. At latest Follow-Up: Retirement
No. (%)
Retirement from professional sports 16 (22.5)
Age 5 (31.25)
Without a Club 4 (25)
Studies 5 (31.25)
Knee 1 (6.25)
Other injuries 1 (6.25)

16. Total number of contralateral ACL ruptures 19 (27.1%)
Before index procedure 9 (12.8%)
After index procedure 10 (14.3%)
Contralateral Graft Ruptures

17. Re-operations – 51.4%!!

18. Overall 67% still on active roster 3
months after ACLR

19. Conclusions
Combined ACL and ALL reconstruction is associated with excellent outcomes in professional
athletes with respect to graft rupture rates, return to sport, and re-operation rates

20. Thank you!