Combined ACL and Anterolateral Ligament Reconstruction: A Retrospective Comparative Study of Clinical Outcomes

Objective: Residual instability may persist after isolated anterior cruciate ligament (ACL) reconstruction. Anterolateral ligament (ALL) augmentation has been suggested to enhance stability, though its clinical utility remains uncertain.Methods: This retrospective cohort study included 60 patients: 30 underwent isolated ACL reconstruction and 30 underwent combined ACL+ALL reconstruction. Outcomes included clinical stability, functional scores (IKDC, Lysholm), return-to-sport parameters, satisfaction, and complications with a mid-term follow-up of ≥12 months. The study was approved by the institutional non-interventional ethics committee.Results: Baseline demographic and perioperative characteristics were comparable between groups. Postoperatively, the ACL+ALL group showed lower pivot-shift positivity (7% vs. 27%, p=0.04), higher IKDC and Lysholm scores at 12 months (p<0.05), and shorter return-to-sport time (7.2 vs. 8.1 months, p=0.04). Patient satisfaction was higher (p=0.02), and the overall complication rate was significantly lower in the ACL+ALL group (10% vs. 33%, p=0.04).Conclusion: Combined ACL+ALL reconstruction yielded superior stability, functional recovery, and a more favorable complication profile compared with isolated ACL reconstruction. Given the retrospective design and limited sample size, results should be interpreted cautiously. Larger prospective trials are needed.