The use of ultrasound during Anterolateral Ligament (ALL) reconstruction improves femoral positioning

OBJECTIVES: We developed a minimally invasive technique for ALL reconstruction with the gracilis tendon folded in two strands. This is done by palpating the bone contours or under ultrasound control. Our hypothesis is that ultrasound control improves the positioning of the graft. METHODS: We conducted a prospective controlled before-after study. All the patients who had an anatomical ALL reconstruction surgery were included. Patients for whom the postoperative control radiographs of a strict cross-section of the knee did not meet the quality criteria were excluded. The first 60 patients included were palpated for lateral epicondyle location, and for the next 60 patients ultrasound was used. The primary endpoint was the distance measured along an antero-posterior and proximo-distal axis between the graft insertion point and the theoretical ALL insertion point. The comparative analysis was carried out by student’s t-test. We determined the number of subjects to be included at 60 per group by assuming a minimum of 90% of grafts ≤5 mm in the "US" group versus 50% in the "palpation" group. RESULTS: 120 patients were included in 2 groups of 60 (US vs. palpation) with no statistical difference. The mean anteroposterior distance between the theoretical point and the point identified in the palpation group was 6.3 mm (+/- 2.4) and 1.2 mm (+/- 1.1) in the ultrasound group (p<0.001). CONCLUSION: Our hypothesis was confirmed. Ultrasound control improves the positioning of the ALL graft.