SURGERY OR NOT? Studies emphasize the importance of a “tailor-made” approach (Fithian et al 2005) 14 adapting the choice of graft and technique to the patient’s characteristics and level of risk. Post-operative rehabilitation is lengthy (often 6 to 9 months before returning to pivoting activities). In high-level skiing, a return to competition is recommended after 1 year.
This issue can often be summarized by two points: athlete or non-athlete? Stability or instability in everyday life or sports?
For high-level skiers, young athletes, or in cases of major rotational laxity (grade 2 or 3 on the Pivot-Shift test), it is increasingly recommended to combine intra-articular reconstruction with anterolateralplasty (ALP) or extra-articular tenodesis (e.g., Lemaire type on the fascia lata). This is currently the most commonly performed surgery for high-level skiers. The objective is to control anterolateral instability (resort or pivot-shift), which is particularly affected by torsional stresses during skiing (new ski characteristics, edge changes, jump landings, heavy snow). This ACL+ PCL combination is often recommended for people at high risk of recurrence, including young athletes (< 25 years old) who participate in pivot-contact sports.
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