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 anterolateral 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 using hamstring tendon autografts 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 patients (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, a 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 performance. The mean Tegner activity score decreased from 7.9 ± 1.4 preoperatively to 7.2 ± 1.8 postoperatively (paired t-test, p < 0.0001; Wilcoxon signed-rank test, p < 0.0001). Postoperative complications occurred in 18 patients (6.2%), the majority of which related to meniscal re-ruptures. 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 also being a safe procedure without significant complications. These findings support the use of this technique in young and professional athletes where rotational stability is necessary.