Modified Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction in 291 High-Level Athletes: Clinical Outcomes at Minimum 2.5-Year Follow-up

Background and Objectives: Combined anterior cruciate ligament (ACL) and anterol-ateral ligament (ALL) reconstruction has been advocated to improve rotational stability and reduce graft failure in high-risk athletes. We aimed to evaluate the mid-term functional outcomes of a modified combined ACL and ALL reconstruction technique developed at our institution. Materials and Methods: We retrospectively reviewed 395 patients who underwent combined ACL and ALL reconstruction between 2018 and 2022. Of these, 291 (73.6%) completed the minimum follow-up of 2.5 years and were included in the analysis. Primary outcomes were graft rerupture and return to sport (RTS) at the pre-injury level. Secondary outcomes included graft survival, change in Tegner score from pre-injury to follow-up and complications. Results: The cohort consisted of 219 males (75.3%) and 72 females (24.7%), with a mean age of 20.6 ± 4.0 years (range 14–35). Eleven patients experienced graft rerupture, yielding a rate of 3.78% (95% CI, 2.1–6.6). At final follow-up, 220 patients (75.6%; 95% CI, 70.4–80.2) returned to their pre-injury level of sport. Conclusions: Our modified combined ACL and ALL reconstruction technique demonstrated excellent mid-term results in a high-risk athletic population, with low rerupture rates and high RTS rates, while being safe procedure without significant complications. These findings support the use of this technique in young and professional athletes where rotational stability is necessary.