Anterior lateral ligament (ALL) reconstruction may be performed together with anterior cruciate ligament (ACL) reconstruction in patients with excessive knee instability related to injury of the ALL.
In selected patients, reconstructing the ALL can help the reconstructed ACL provide rotational stability to the knee.
What Is ALL Reconstruction?
The ALL may be reconstructed in addition to the ACL when significant laxity or rotational instability is present.
Dr. Chudik may recommend ALL reconstruction in special cases after an ACL injury or failed ACL reconstruction when excessive knee instability related to the ALL is present.
During surgery, the failed ALL is replaced with a new graft and fixed into place using additional limited incisions. Once healed, the reconstructed ALL assists the reconstructed ACL with rotational stability of the knee.
Who Is a Candidate?
ALL reconstruction may be recommended for:
- Patients who have failed a previous ACL reconstruction, have an ALL injury, and regularly participate in sports requiring pivoting, cutting, jumping, and landing
- Patients with ACL and ALL injuries who have significant laxity or rotational instability demonstrated by pivot shift
For individuals who do not participate in sports requiring frequent pivoting, cutting, jumping, and landing, surgery may not always be the best option.
Patients who are unable or unwilling to complete the necessary postoperative rehabilitation program should not have surgery. A current or previous knee infection is a concern, although it is not an absolute contraindication. Severe knee arthritis and damaged cartilage are also contraindications.
How the Procedure Is Performed
Dr. Chudik performs ALL reconstruction together with ACL reconstruction as an outpatient procedure, allowing the patient to go home the same day.
The surgery is performed with general anesthesia and a nerve block. The failed ALL is replaced by a new graft and secured using additional limited incisions.
Once healed, the reconstructed ALL assists the reconstructed ACL in providing rotational stability to the knee.
Recovery and Rehabilitation
Recovery follows the ACL reconstruction rehabilitation program. ALL reconstruction does not add additional recovery time.
Following surgery:
- Crutches and partial weight bearing are used for approximately four weeks for an isolated ACL reconstruction
- A postoperative knee brace is used for 24 hours if a regional femoral block was used, or for six weeks if the meniscus or another ligament was also repaired or reconstructed
- The wound should be kept clean and dry for the first 10 to 14 days
- Light showering is allowed after two weeks, but the wounds should not be submerged in water for three weeks
- Driving may resume after six weeks when the right leg is involved
- Return to school or sedentary work may occur in less than one week as long as the leg can be elevated and the patient can use crutches
- Physical therapy to restore motion, strength, and proprioception (balance) may continue for four to six months
After the knee is fully rehabilitated, Dr. Chudik performs ACL Return to Sport Testing to determine whether rehabilitation is complete and whether movement patterns known to increase the risk of injury to the reconstructed ACL or the other knee have been corrected.
Return to walking and regular daily activities may occur once the patient is off crutches, generally about four to six weeks after surgery. Return to running may occur at about three months, with return to sports at approximately four to six months.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Nerve injury resulting in numbness around the knee; a small area of temporary or permanent numbness around the incisions is not uncommon
- Postoperative infection that may require staged surgery and removal of the graft
- Re-rupture or stretching of the reconstructed ligament, causing recurrent instability, which is more common with allografts
- Knee stiffness requiring prolonged rehabilitation or repeat surgery
- Rare pain from the fixation device used to hold the graft
- Rarely, a blood clot in the veins of the calf or thigh that may travel to the lungs
Once healed, the reconstructed ALL assists the reconstructed ACL with rotational stability of the knee. Initial studies have shown a decreased incidence of recurrent ACL injury when ALL reconstruction is added in appropriate cases.
Why Dr. Chudik for ALL Reconstruction
Dr. Chudik evaluates patients with ACL and ALL injuries for significant laxity and rotational instability. In selected cases, including failed ACL reconstruction with associated ALL injury, he may recommend reconstructing the ALL together with the ACL.
The ALL is reconstructed with a new graft through limited additional incisions to assist the reconstructed ACL in restoring rotational stability to the knee.