Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction

Abstract

Purpose The aim of the study was to compare three different procedures performed by the same surgeon: monobundle patellar tendon reconstruction (bone-patellar tendonbone, BPTB), double-bundle hamstring reconstruction (DBH) and mono-bundle patellar tendon combined with extraarticular reconstruction (Lemaire) (BPTB + L). Methods A total of 75 patients (25 in each group) were evaluated at a mean follow-up of 25 months. Laxity was assessed pre-and post-operatively with Telos™ stress radiographs (15 kg). The amount of anterior tibial translation (ATT) corrected by the surgery was quantified. Secondary outcomes were International Knee Documentation Committee (IKDC) scores, pivot shift grading, pain complaints, sensory deficits, subsequent surgical procedures, return to sports and patients' ability to kneel or squat on their affected knee. Results Absolute correction of ATT for the internal compartment was not statistically significant [analysis of variance (ANOVA), p=0.377]. For the external compartment BPTB + L (8.2 mm) showed superiority over DBH (5.6 mm) and BPTB (4

Biomechanical evaluation of augmented and nonaugmented primary repair of the anterior cruciate ligament: an in vivo animal study

“…Although there is still some debate about the optimal treatment for acute ACL tears, surgical management in the young and active patient is recommended [7][8][9][10]. Operative procedures include extra-articular techniques, primary repair and reconstruction using autografts, allografts, xenografts, and artificial ligaments [10][11][12][13][14][15][16][17][18]. Currently, reconstruction using autograft or allograft tendon material seems to be the gold standard of surgical treatment.…”

Lateral tenodesis combined with anterior cruciate ligament reconstruction using a unique semitendinosus and gracilis transplant

“…Furthermore, rotational instability increases the risk of meniscal and cartilaginous lesions and predisposes to arthritic changes [5]. As such, several strategies have been developed in an attempt to better control coronal stability including more lateral positioning of the femoral tunnel [6,7], double-bundle reconstructions with a posterolateral bundle dedicated to controlling internal rotation [8,9] and combined intraand extra-articular techniques [10][11][12][13][14][15]. Such hybrid techniques allow the anterolateral stabilising structures to be reconstructed because they are always torn in cases of rotatory instability [16].…”

The Fascia Lata Anterolateral Tenodesis Technique

“…A strip of ITT has been widely used in the past for extra-articular nonanatomic tenodesis, [12][13][14] with good results at long-term follow-up. 15,[23][24][25] Moreover, the biomechanical effect of such procedures in controlling rotational stability of the knee has also been shown with the aid of navigation. 6,17 However, all these techniques, acting with nonanatomic behavior, took advantage from the long lever arm not reproducing the anatomy of the lateral aspect of the knee.…”

“…Second, because the ITT is another important secondary restraint of the knee, the use of a strip of ITT could weaken such a structure. 26,27 Nevertheless, strips of ITT have been widely used for extra-articular tenodesis in the past, [12][13][14] with no relation in long-term follow-up results 15,[23][24][25] in terms e84 of osteoarthritis. Moreover, the reconstruction is performed under the ITT, which can be sutured at the end of the procedure.…”