Antero Lateral Ligament Reconstruction by Modified Sonnery Cottet Technique

Abstract Introduction: With the rising popularity of high-demand sports such as soccer and kabaddi in our country, anterior cruciate ligament (ACL) tear or injury has become a very common sports injury. People with such injuries who wish to get back to their preinjury level of active physical life need a strong and stable anatomical ligament reconstruction. Studies have shown that combined ACL and anterolateral ligament (ALL) reconstruction has better outcomes than isolated ACL reconstruction. Sonnery–Cottet technique is one among the many techniques of ALL reconstruction used. We have developed a modified Sonnery–Cottet technique of ALL reconstruction, which is equally effective and less expensive for the patient. Aims and Objectives: The aim was to demonstrate the effectiveness of a modified Sonnery-Cottet technique of combined ACL and ALL reconstruction in patients with high-grade ACL tear. The primary objective was to compare the preoperative and postoperative International Knee Documentation Committee (IKDC) score for subjective knee evaluation. The secondary objectives were to evaluate ACL graft rupture rates and any postoperative complications. Materials and Methods: This interventional prospective study was carried out in 2021–2023 on 41 patients with high-grade ACL injury. All were aged between 18 and 30 years; 39 patients were male and two were female. The presurgery IKDC score was calculated. Combined ACL and ALL reconstruction were done in all the patients in which ACL reconstruction was done with quadrupled semitendinosus graft, and ALL reconstruction was done with a single strand of gracilis graft with its insertion site intact. All the patients were followed up at 3, 6, and 12 months postoperatively, and their IKDC score were calculated. ACL graft rupture and any other postoperative complications were also looked for. Results: The mean (± standard deviation [SD]) presurgery IKDC score was 46.7 ± 11.8. The mean (±SD) postsurgery IKDC score at 3, 6, and 12 months were 50.8 ± 7.2, 75 ± 7.9, and 90.3 ± 9.1, respectively. The results at the end of 12 months postsurgery are statistically significant (paired t -test; P < 0.0001). In our study, one patient suffered from rupture of graft and revision surgery was done with bone patellar tendon bone graft. Thirty-two patients (78%) were back to preinjury level activities. Two patients (4.8%) developed arthrofibrosis and postoperative infection. Conclusion: The results obtained from this study were comparable with those of similar studies done previously. The two main advantages of this modified Sonnery–Cottet technique were the four-fold semitendinosus graft having a diameter of 8 mm with single strand live gracilis graft, which resulted in a thick and robust ACL graft and less cost as no extra implant was required. The limitation was the small sample size.