Chapter 13: Indications for Ancillary Surgery in the ACL-Deficient Knee

Biju Benjamin M.D., Robert A. Magnussen M.D., Philippe Neyret M.D.

BOOK CHAPTER: The ACL-Deficient Knee, Editors: Vincente Sanchis-Alfonso and Jaon Carles Monliau



Modern ACL reconstruction frequently provides a stable knee and allows a majority of athletes to return to sport. However, the incidences of failed surgery and progression of degenerative disease remain unacceptably high. Ancillary procedures including lateral extra-articular reconstruction, valgus- producing HTO, tibial deflexion osteotomy, and procedures related to meniscal preservation and restoration may provide routes for improving results. These procedures augment ACL reconstruction by decreasing stress on the intra-articular graft, improving stability by decreasing anterior tibial translation and/or the pivot shift, and decreasing stress on the articular cartilage by altering load transmission and/or decreasing shear stress due to abnormal joint kinematics. Further work, including development of new techniques and welldesigned prospective studies evaluating results, is necessary to improve and verify the utility of these procedures.


Correspondence: Dr. Biju Benjamin, Department of Orthopaedic Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam. E-mail: