Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play

Abstract

Purpose To determine whether isokinetic muscle recovery following ACLR using a hamstring tendon (HT) would be equivalent (non-inferior) in knees that had high-grade pivot-shift and adjuvant modified Lemaire procedure versus knees that had minimal pivot-shift and no adjuvant modified Lemaire procedure. Methods We evaluated 96 consecutive patients that underwent primary ACLR. Nine were excluded because of contralateral knee injury, and of the remaining 87, ACLR was performed stand-alone in 52 (Reference group), and with a Lemaire procedure in 35 (Lemaire group) who had high-grade pivot-shift, age < 18, or genu recurvatum > 20°. At 6 months, isokinetic tests were performed at 240°/s and 90°/s to calculate strength deficits of hamstrings (H) and quadriceps (Q). At 8 months, patients were evaluated using IKDC, Lysholm, and Tegner scores. Results Compared to the Reference group, the Lemaire group were younger (23.0 ± 2.5 vs 34.2 ± 10.5, p = 0.021) with a greater proportion of males (80% vs 56%, p < 0.001). The Lemaire group had no complications, but the Reference group had one graft failure and one cyclops syndrome. Strength deficits at 240°/s and at 90°/s were similar in both groups, but mixed H/Q ratios were lower for the Lemaire group (1.02 ± 0.19 vs 1.14 ± 0.24, p = 0.011). IKDC and Lysholm scores were similar in both groups, but Tegner scores were higher in the Lemaire group (median, 6.5 vs 6.0, p = 0.024). Conclusions ACLR with a modified Lemaire procedure for knees with rotational instability grants equivalent isokinetic muscle recovery as stand-alone ACLR in knees with no rotational instability. For ACL-deficient knees with high-grade pivot-shift, a Lemaire procedure restores rotational stability without compromising isokinetic muscle recovery. Study design Level III, comparative study.

Return to Sports After ACL Augmentation With Anterolateral Reconstruction (ALR) Harvesting Gracilis Only Compared With ACL Reconstruction With ALR Harvesting Both Hamstring Tendons

“…18 Also, in terms of morbidity gain, we could discuss replacing ALR with gracilis via a lateral extra-articular tenodesis with fascia lata, for which isokinetic tests have already proven its absence of consequences. 27 One might think that a better ability to return to sports in the ACL-Rp group could lead to a safer return to sports and therefore less rerupture, but this was not the case. We already know that a safe return to sports is not the only known protective factor of rerupture, 33,55 and ACL-Rp is known to be a technique with a higher risk of rerupture (from 4% to 15% at a short-term follow-up 16,22,25,38,39,41 ).…”

“…18 Also, in terms of morbidity gain, we could discuss replacing ALR with gracilis via a lateral extra-articular tenodesis with fascia lata, for which isokinetic tests have already proven its absence of consequences. 27…”

Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis

“…Our results indicate that at minimum 2 years follow up, patients treated with a combined procedure have equivalent to superior outcomes, which is consistent with recent systematic reviews [ 4 , 62 ], but deviates from older reviews [ 7 , 23 , 48 ]. Possible explanations for these superior results are the improved knee rotatory stability with the newer, more dedicated LA procedures along with the observed equivalent isokinetic muscle recovery in patients treated with ACLR + LA [ 13 , 28 ]. These findings are also likely the reason of the higher, although not significant, degree of return to sports observed in the ACLR + LA treated group.…”

Lateral Extra-Articular Tenodesis via an All-Suture Anchor

“…The modified Lemaire lateral extra-articular tenodesis (LET) technique is intended to help assist with anterolateral rotatory instability upon injury to the anterolateral complex and to protect the ACL graft and meniscus. 6…”

“…5 The modified Lemaire lateral extra-articular tenodesis (LET) technique is intended to help assist with anterolateral rotatory instability upon injury to the anterolateral complex and to protect the ACL graft and meniscus. 6 The anterolateral complex is a set of structures most important to the prevention of internal tibial rotation at the knee. 10 The ALC consists of the superficial and deep iliotibial (IT) band, capsulo-osseous layer of the IT band and Kaplan fibers, the anterolateral capsule, including the mid-third capsular ligament, and the anterolateral ligament (ALL).…”