Two-year outcomes following concomitant ACL and extra-articular ligament reconstruction: a nationwide analysis of over 5,000 patients.

Authors

Rayyan Abid, Robert J Burkhart, Andrew J Moyal, Jeremy M Adelstein, Mark Kodsy, Jacob G Calcei, James E Voos, John M Apostolakos

Published in

Archives of orthopaedic and trauma surgery. Volume 146. Issue 1. Aug 10, 2026. Epub Aug 10, 2026.

Abstract

The anterior cruciate ligament (ACL) is the most commonly injured and reconstruction ligament in the United States. Associated injuries are common, oftentimes including components of the extra-articular knee. However, complications following concomitant ACL and extra-articular ligaments (EAL) has not been defined in a large-scale, population-based sample. We aimed to analyze outcomes following concomitant ACL and EAL reconstruction using the TriNetX nationwide database.ep METHODS: Deidentified data from the TriNetX Collaborative Network was used to identify all patients who received ACL and EAL reconstruction on the same day. Demographic information including age, sex, race, and geographic data were collected. Rates of medical and orthopaedic complications were analyzed at 30, 90, and 180 days and at 2 years. A propensity matched sub-analysis comparing outcomes patients with concomitant and staged repair was performed. Patients were identified using Current Procedural Terminology (CPT) coding.
We identified 5944 patients who received concomitant ACL and EAL reconstruction with postoperative outcomes available at 30, 90, and 180 days. 5040 patients had data available at 2 years. Serious medical complications like surgical site infection, deep vein thrombosis, acute kidney failure, and sepsis were rare at each point of follow-up. Rates of revision surgery were low at short-term follow-up but were prevalent for both procedures at 2 years (> 2%). The most common orthopaedic complications osteoarthritis, implant/graft failure, and knee instability. However, these incidences remained below 7.5% at each interval. Outcomes were similar for staged and concomitant reconstruction, but osteoarthritis, implant/graft failure, and knee instability were significantly more common in the former group at various points.
Concomitant ACL and EAL reconstruction demonstrated negligible rates of serious medical complications. While rates of osteoarthritis, instability, and graft failure increased at each point, these were generally comparable to independent ACL and EAL procedures. While there was little difference in outcomes between staged and concomitant reconstruction, the latter should be preferred due to lower rates of osteoarthritis, graft failure, and instability.
Level III.

PMID:
42573786
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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