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.