Clinical comparison of the effectiveness of treatment of anterior and rotational instability of the knee joint in arthroscopic anterior cruciate ligament repair, complemented with anterolateral ligament plasty or extraarticular tenodesis in athletes

Relevance: There are two concepts for stabilizing the anterolateral corner: free anterolateral ligament reconstruction and extra-articular anterolateral tenodesis from ilitibial band. There are currently insufficient data to assess long-term clinical efficacy and indications for surgical treatment.Materials and methods: A retro- and prospective clinical study was carried out on the basis of the Department of Traumatology and Orthopedics of the Central Clinical Hospital of the Russian Academy of Sciences from 2016 to 2018. The study included 69 patients involved in sports at the amateur and professional levels of occupation: 4 (5.8%) women and 65 (94.2%) men, whose average age was 27.10 ± 6.84 years, with a diagnosis “rupture of the anterior cruciate ligament of the knee”. The patients were divided into two groups depending on the type of surgery: one group included patients who underwent arthroscopic ACL repair supplemented with ALL plasty with a tendon autograft; the other group included patients who received arthroscopic reconstruction of the ACL, supplemented by ET from ilitibial band. All patients were questioned on the Tegner-Lysholm scale, a subjective form of the IKDC-2000 questionnaire for the 1st, 2nd and 3rd years after surgery.Results: According to the research results, the results of surgical treatment can be assessed as good and excellent in two groups. An intergroup comparison of surgical treatment results at the end of the first year from the moment of surgery to the first and third years from the moment of surgery revealed statistically significant differences in patients playing football and wrestling in favor of ALL plasty according to the Tegner-Lysholm scales (p = 0.000223), Tegner- Lysholm (p = 0.000223) and the subjective form of the IKDC-2000 scale (p = 0.000005416), respectively.Conclusions: Reconstruction of ACL can be supplemented with extra-articular tenodesis or anterolateral ligament plasty, which allows achieving higher functional results in patients actively involved in sports at various levels (amateurs, professionals). Free anterolateral ligament repair of the knee can be recommended for football players and patients involved in sports in which there are multiple changes of movement direction, acceleration and twisting loads.