Anterolateral Ligament Reconstruction Practice Patterns Across the United States

BACKGROUND: A proposed mechanism for recurrent instability following anterior cruciate ligament (ACL) reconstruction is failure of the anterolateral ligament (ALL). Presently, there are a number of approaches to treating ALL pathology. PURPOSE: To determine practice patterns among orthopaedic surgeons regarding ALL during ACL reconstruction. STUDY DESIGN: Cross-sectional study. METHODS: An online 7-question survey was sent to all physicians registered with the American Orthopaedic Society for Sports Medicine between June and July 2017. Results were analyzed with the survey website. RESULTS: Overall, 225 of 3467 surgeons responded to the survey, 86 of whom performed ALL reconstruction and completed each question in the survey. Eighty-six (38.2%) surgeons who responded to the questionnaire stated that they perform ALL reconstruction/lateral extra-articular tenodesis in conjunction with ACL reconstruction. The most common indications for ALL reconstruction were grade III pivot-shift test (46.0%) on physical examination and revision ACL reconstruction (46.0%). The most common technique used to perform ALL reconstruction was hamstring autograft (48.2%). The majority of participating surgeons (87.5%) stated that they do not make any alterations to their postoperative rehabilitation protocol after they perform ALL reconstruction. In addition, most surgeons responding to the survey (91.3%) anticipated either an increase in or the same number of ALL procedures performed in the coming year. CONCLUSION: The majority of surgeons who responded to the survey did not routinely reconstruct the ALL. Revision procedures and grade III pivot shift were the most cited indications for performing lateral augmentation. Anatomic reconstruction with hamstring was the most commonly used procedure, although there was no consensus among surgeons responding to the survey. Understanding the ALL and its contribution to knee stability is essential. For a community of physicians, it is useful to discover how fellow sports orthopaedic surgeons address ALL pathology to integrate effective and efficient treatment strategies into practice.