ROTATIONAL STABILITY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION COMBINED WITH ANTEROLATERAL AUGMENTATION

Maciej Wiśniecki; Martyna Rynkowska; Natalia Bogumiłło; Bartłomiej Baszun; Katarzyna Kulszo; Dawid Żuraw; Krzysztof Mirkowski; Karolina Klusek; Magda Kijowska; Magda Kowaleczko

doi:10.31435/ijitss.3(51).2026.5743

Authors

Maciej Wiśniecki Stefan Cardinal Wyszyński Provincial Specialist Hospital SPZOZ in Lublin, Lublin, Poland https://orcid.org/0009-0002-1152-2835
Martyna Rynkowska Stefan Cardinal Wyszyński Provincial Specialist Hospital SPZOZ in Lublin, Lublin, Poland https://orcid.org/0009-0003-8976-2318
Natalia Bogumiłło University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0002-7567-2242
Bartłomiej Baszun University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0003-1694-4268
Katarzyna Kulszo Stefan Cardinal Wyszyński Provincial Specialist Hospital SPZOZ in Lublin, Lublin, Poland https://orcid.org/0000-0002-8573-9714
Dawid Żuraw University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0004-3160-5659
Krzysztof Mirkowski University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0009-6976-0810
Karolina Klusek Stefan Cardinal Wyszyński Provincial Specialist Hospital SPZOZ in Lublin, Lublin, Poland https://orcid.org/0009-0004-7006-0188
Magda Kijowska Stefan Cardinal Wyszyński Provincial Specialist Hospital SPZOZ in Lublin, Lublin, Poland https://orcid.org/0009-0004-1086-7086
Magda Kowaleczko University Clinical Hospital No. 1 in Lublin, Lublin, Poland https://orcid.org/0009-0000-6055-0141

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5743

Keywords:

Anterior Cruciate Ligament; Anterolateral Ligament; Lateral Extra-Articular Tenodesis; Rotational Instability; Pivot Shift

Abstract

Background and Objective: Residual rotational instability after anterior cruciate ligament reconstruction remains a clinically relevant problem, particularly in young and active patients returning to cutting and pivoting sports. This structured narrative review evaluates whether anterior cruciate ligament reconstruction combined with anterolateral augmentation improves rotational stability compared with isolated reconstruction.

Methods: A structured PubMed search was conducted for English-language studies published between 2013 and 2025 addressing anterior cruciate ligament reconstruction, anterolateral ligament reconstruction, lateral extra-articular tenodesis, rotational instability, and pivot shift. Comparative clinical studies, randomized trials, systematic reviews, meta-analyses, and relevant biomechanical investigations were prioritized.

Results: Current evidence suggests that combined reconstruction provides more consistent pivot-shift control than isolated anterior cruciate ligament reconstruction, especially in selected high-risk groups such as young athletes, patients with high-grade pivot shift, and selected revision cases. Randomized and pooled evidence also indicates reduced graft failure rates in some high-risk cohorts, although patient-reported functional outcomes are often similar between isolated and combined procedures.

Conclusions: Combined anterior cruciate ligament reconstruction with anterolateral augmentation may enhance rotational stability and reduce failure risk in selected patients. However, routine use in all primary reconstructions cannot be recommended without stronger standardized long-term evidence.

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