Combined ACL and ALL Reconstruction Significantly Reduces Graft Failure in High-Risk Young Patients: 5-Year RCT Evidence

Introduction: The Persistent Challenge of ACL Failure in Youth

Anterior Cruciate Ligament (ACL) rupture remains one of the most common and impactful musculoskeletal injuries in sports medicine. While surgical reconstruction (ACLR) has long been the gold standard for restoring knee stability, the orthopedic community has faced a persistent challenge: high graft failure rates in young, active populations. Despite technical refinements and the use of various autografts, failure rates in patients under 25 years old can often exceed 10-15%, leading to significant morbidity and the need for complex revision surgeries.

In recent years, attention has shifted toward the role of the anterolateral complex of the knee. Biomechanical studies have suggested that isolated ACLR may not sufficiently control the internal rotatory instability that often accompanies high-grade ACL injuries. This has led to the revival and refinement of the Anterolateral Ligament Reconstruction (ALLR) as an adjunctive procedure. However, high-level clinical evidence comparing combined ACLR+ALLR against the traditional ‘gold standard’—the Bone-Patellar Tendon-Bone (BPTB) autograft—has been limited until now.