Arthritis and Lateral Surgery With ACL Recon — Associated or Not?

Lateral reconstructions at the time of ACL reconstruction are gaining traction, but do they increase the risk of premature arthritis?

Arthritis and Lateral Surgery With ACL Recon — Associated or Not?
Smart Practice: Add lateral ligament reconstruction to your ACL reconstruction for lower risk of re-rupture if you wish, but don’t count on this new study’s findings about its safety vis-à-vis the later development of arthritis.

What’s the Claim?

A controlled observational study at about 9 years of follow-up found that adding anterolateral ligament reconstruction (ALLR) to ACL reconstruction alone:

  • Was not associated with increased odds of developing arthrosis on plain radiographs of the medial or lateral tibiofemoral joint
  • Was associated with lower odds of medial patellofemoral arthrosis
  • Was not associated with increased risk of subsequent meniscal surgery or differences in patient-reported outcomes scores

How’s It Stack Up?

Lateral surgery (ALLR) has been front-of-mind since two-year results from the STABILITY trial demonstrated a rather dramatic reduction in the risk of ACL re-rupture when reconstruction was augmented with lateral extra-articular tenodesis (4% re-ruptured with augmented reconstructions vs. 11% re-ruptured among those with ACL reconstruction alone). The specific reconstructive approach for the lateral side differed, but the concept is similar enough, and a prior observational study from the same group whose work we’re covering here likewise showed substantially better ACL graft survivorship when they added an ALLR.

Prior retrospective studies evaluating the addition of lateral-sided procedures have suggested that they increase the risk of lateral tibiofemoral arthrosis, but these studies were difficult to interpret because they did not control for meniscal injury that was present at the time of ACL reconstruction. The current study did so (and controlled for a number of other important variables, as well).

What’s Our Take?