Comparable outcomes following combined ACL and ALL reconstruction using a 1‐strand versus 2‐strand back‐and‐forth technique: Propensity score matched study

Abstract Purpose To compare post‐operative laxity and clinical outcomes following combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction with hamstring grafts using a 1‐strand versus 2‐strand back‐and‐forth technique. Methods The authors retrospectively assessed a consecutive series of 348 patients (348 knees), that underwent combined ACL and ALL reconstruction using the 2‐strand technique, and 130 patients (130 knees), that underwent combined ACL and ALL reconstruction using 1‐strand technique between January 2020 and December 2022. Propensity score matching was performed to establish two comparable study cohorts. Patients underwent pre‐ and postoperative assessment by one observer using Knee injury and Osteoarthritis Outcome Score (KOOS‐12), Lysholm, Tegner, and ACL‐RSI scores. Physical examinations included a jerk test, and the attribution of a Lachman grade. Postoperatively, patients were assessed using the Dyneelax arthrometer on both knees to measure the differential laxity in anterior translation (AT) and internal rotation (IR). Results Propensity score matching resulted in 70 patients in the 2‐strand group, and 70 patients in 1‐strand group. Post‐operatively, 18 patients were lost to follow up, and five patients underwent revision surgery due to a retear. This left a final cohort of 58 patients in the 2‐strand group, aged 30.5 ± 8.1 (range, 18–52), with a BMI of 25.8 ± 4.3 (range, 20–37.8), and 59 patients in the 1‐strand group, aged 30.7 ± 10.7 (range, 15–55), with a BMI of 26.5 ± 3.9 (range 16.9–38.6). At a mean follow‐up of 2.4 ± 0.4 years, there were no significant differences between the groups in terms of differential laxity in AT, IR, KOOS‐12, ACL‐RSI, Lysholm, Tegner scores, and retear rates. Conclusion There was no significant difference between the 1‐ and 2‐strand techniques for combined ACL and ALL reconstruction in terms of post‐operative laxity, functional and clinical outcomes, including return to sport and Tegner activity level, suggesting that both techniques are equally effective in restoring knee stability and function. Level of Evidence Level IV, case series.