Han JH, et al. Clin Orthop Surg. 2025 Feb;17(1):112-122. https://doi.org/10.4055/cios24285

Objectives: The aim of this study is to evaluate the literature for comparing clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with concomitant anterolateral ligament reconstruction (ALLR) versus isolated ACLR, with a primary focus on analyzing differences in outcomes based on the type of graft used for ALLR. Methods: We identified comparative studies involving primary ACLR performed in conjunction with ALLR. Graft failure rates, residual pivot shift, residual anterior–posterior (AP) laxity at follow-up, and patient-reported outcome measures were determined. Variables associated with isolated ACLR and ACLR combined with ALLR were compared based on the type of graft used for ALLR. Results: This systematic review included nine studies involving 2740 patients. Combined ACLR with ALLR using hamstring tendon (HT) autografts or tibialis allografts showed lower graft failure rates than isolated ACLR (HT autograft: rate, 0–5.9%, odds ratio [OR], 2.16–12.91; tibialis allograft: rate, 0%, OR, 2.00–5.27). Similarly, the combined procedure showed reduced residual pivot shift rates (HT autograft: rate, 0–9.1%, OR, 2.00–12.16; tibialis allograft: rate, 0%, OR, 7.65–15.33) compared to isolated ACLR. Residual AP laxity and patient-reported outcomes were similar or more favorable for the combined procedure; however, the results were heterogeneous. Complications related to the type of graft used for ALLR or the presence of ALLR itself were not reported. Conclusions: Regardless of the graft type used for ALLR, the combination of ACLR with ALLR showed better clinical outcomes, including reduced graft failure rates and superior residual rotational stability compared to isolated ACLR. However, the high heterogeneity observed across studies suggests that these findings should be interpreted with caution, and further research is needed to draw more definitive conclusions.

High tibial osteotomy (HTO) is crucial for managing medial compartmental knee osteoarthritis. Precision in achieving the medial proximal tibial angle (MPTA) correction and maintenance of posterior tibial slope (PTS) is essential for clinical success. This study aims to compare the use of 3D-printed patient-specific instruments (PSI) to conventional HTO to achieve precise MPTA correction and maintenance of PTS, aiming to enhance surgical outcomes in HTO patients. Among 104 patients who underwent HTO between September 2018 and July 2021, 60 met the inclusion criteria and were categorized into a PSI group (30 cases) and conventional method group (30 cases). Radiological outcomes included estimated and postoperative MPTA values, along with preoperative and postoperative PTS measurements. Within the conventional HTO group, significant differences were noted between the estimated and postoperative MPTA values (94.3° ± 2.4° vs. 93.5° ± 2.5°, P = 0.023), as well as between the preoperative and postoperative PTS values (8.8° ± 3.2° vs. 7.9° ± 3.5°, P = 0.033). Conversely, the PSI group did not exhibit any significant differences in these values. This study indicated that the use of PSI-guided HTO could provide enhanced accuracy in achieving the target MPTA and improve the prevention of PTS changes.

Background: Anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autograft is a common procedure for which interest is increasing regarding the use of platelet-rich plasma (PRP) to enhance surgical outcomes. Purpose: To systematically review the effect of PRP augmentation on the clinical outcomes of ACLR using HT autografts through a meta-analysis of randomized controlled trials (RCTs). Study Design: Meta-analysis; Level of evidence, 2. Methods: The PubMed, Embase, Cochrane Library, and Google Scholar databases were comprehensively searched for articles published up until November 1, 2024. The inclusion criteria were RCTs that reported clinical outcomes of patients undergoing ACLR with HT autografts involving PRP augmentation. The methodological quality of the selected studies was assessed using the Cochrane Collaboration’s risk-of-bias tool. Results: Among 1722 studies initially identified across databases, 11 studies with 583 patients were included in the analysis. The results of the meta-analysis indicated that PRP significantly improved residual anterior-posterior laxity at 3 months (mean difference [MD], –1.12; 95% CI, –1.64 to −0.60; P < .001) and 6 months (MD, –2.00; 95% CI, –3.17 to −0.83; P < .001) but not at 12 months (MD, 0.03; 95% CI, –0.31 to 0.38; P = .847). The Lysholm score did not differ significantly between the PRP and control groups at 3 months (MD, 0.34; 95% CI, –1.20 to 1.87; P = .666), 6 months (MD, –3.35; 95% CI, –10.68 to 3.98; P = .370), or 12 months (MD, 0.73; 95% CI, –1.41 to 2.88; P = .502). No significant heterogeneity was observed in any meta-analysis. Conclusion: PRP augmentation in ACLR using HT autografts showed potential short-term benefits including reduced residual anterior-posterior laxity and improved radiological findings. However, these effects were not sustained in the long term, and no significant differences in patient-reported outcomes were observed over time.