Anterolateral ligament (ALL) reconstruction is a surgical procedure often performed in conjunction with anterior cruciate ligament (ACL) reconstruction to address rotational instability of the knee. The anterolateral ligament is a structure located on the outer side of the knee, and it plays a role in stabilizing the knee, particularly during pivoting movements.

Indications for ALL Reconstruction:

• Persistent Rotational Instability: Patients who continue to experience rotational instability (pivot shift) after ACL reconstruction.
• High-Risk Patients: Athletes or individuals with high-demand activities who are at risk of ACL graft failure.
• Revision ACL Surgery: Patients undergoing revision ACL surgery who have previously failed ACL reconstruction.

Surgical Technique:

• Graft Selection: Similar to ACL reconstruction, autografts (from the patient's own body) or allografts (from a donor) can be used.
• Graft Placement: The graft is typically fixed to the femur and tibia at the anatomical attachment sites of the anterolateral ligament.
• Fixation: The graft is secured using screws, buttons, or other fixation devices.

Rehabilitation:

• Initial Phase: Focus on reducing swelling, restoring range of motion, and protecting the graft.
• Intermediate Phase: Gradual strengthening and proprioceptive exercises.
• Advanced Phase: Sport-specific drills and gradual return to activities.

Outcomes:

• Improved Stability: ALL reconstruction can significantly reduce rotational instability and improve overall knee stability.
• Reduced Re-injury Rates: May lower the risk of ACL graft failure, especially in high-risk patients.

Risks and Complications:

• Infection: As with any surgery, there is a risk of infection.
• Graft Failure: The graft may fail, leading to persistent instability.
• Stiffness: Some patients may experience stiffness or limited range of motion post-surgery.

Conclusion:

ALL reconstruction is a valuable adjunct to ACL reconstruction in selected patients, particularly those with significant rotational instability or those at high risk of graft failure. It is essential to have a thorough discussion with your orthopedic surgeon to determine if this procedure is appropriate for your specific condition.