KSSTA - 2026-09-17 - Journal Article
Preserved anterolateral ligament graft continuity on MRI and lower knee laxity after ACL graft failure than before index combined ACL-ALL reconstruction: A retrospective case series.
Leão RV, Takamune DM, da Silva AGM, Camerin GR, Ariel de Lima D, Helito CP
Topics
Key Takeaway
After ACL graft failure following combined ACL-ALL reconstruction, ALL graft continuity was preserved on MRI in 100% of cases, and median ATT was reduced by 2 mm and pivot-shift grade by 1 grade compared to pre-index values.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective case series asked whether the ALL graft remains intact after ACL graft failure in combined ACL-ALL reconstruction and whether residual ALL function attenuates laxity. In 15 patients with ACL graft failure, MRI confirmed ALL continuity in all 15 (100%), with mild signal changes in 9 (60%). Median side-to-side ATT dropped from 7 mm pre-index to 5 mm post-failure (p=0.001), and median pivot-shift grade dropped from 2 to 1 (p=0.001), with 80% of patients showing improvement in both measures.
Key Limitation
The retrospective design with n=15 and mixed primary/revision index procedures precludes causal attribution of laxity reduction to the ALL graft and cannot exclude confounders such as scar tissue, capsular healing, or graft remnant effects.
Original Abstract
PURPOSE
To evaluate magnetic resonance imaging (MRI)-based continuity and signal characteristics of reconstructed anterolateral ligament (ALL) grafts and compare anteroposterior and rotational knee laxity after anterior cruciate ligament (ACL) graft failure with values recorded before the index combined ACL-ALL reconstruction.
METHODS
This retrospective case series included 15 patients who experienced ACL graft failure after combined ACL-ALL reconstruction; the index combined procedure was primary in 12 patients and a revision in 3. MRI was reviewed to assess ALL graft continuity, intrinsic signal changes and periligamentous edema. Side-to-side anterior tibial translation (ATT) measured with the KT-1000 arthrometer and pivot-shift grade were compared between the preindex reconstruction assessment and the assessment after ACL graft failure using Wilcoxon signed-rank tests.
RESULTS
ACL graft failure occurred at a mean of 22 ± 1.5 months (range, 18-24 months) after the index reconstruction. The ALL graft showed preserved continuity on MRI in all 15 patients (100%), and mild signal changes were observed in 9 (60%). Median ATT was lower after ACL graft failure than before the index reconstruction (5 vs. 7 mm; median paired reduction, 2 mm [IQR, 1-3]; p = 0.001). Median pivot-shift grade was also lower (1 vs. 2; median paired reduction, 1 grade [IQR, 1-1.5]; p = 0.001). ATT and pivot-shift grade improved in 12 of 15 patients (80%), and no patient demonstrated a high-grade pivot shift after ACL graft failure.
CONCLUSION
Following ACL graft failure after combined ACL-ALL reconstruction, MRI showed preserved ALL graft continuity in all cases, and knee laxity was lower than before the index reconstruction. In this setting, physical examination findings should be interpreted cautiously because anteroposterior and rotational laxity may be lower than expected. The retrospective design and small, heterogeneous sample preclude causal attribution to the ALL graft and any conclusion that anterolateral revision can be omitted.
LEVEL OF EVIDENCE
Level IV.