Modified Lemaire tenodesis reduces anterior cruciate ligament graft forces during internal tibial torque loading

Abstract

Purpose The aim of the study was to directly measure graft forces of an anterior cruciate ligament reconstruction (ACLR) and a lateral extra-articular tenodesis (LET) using the modified Lemaire technique in combined anterior cruciate ligament (ACL) deficient and anterolateral rotatory instable knees and to analyse the changes in knee joint motion resulting from combined ACLR + LET. Methods On a knee joint test bench, six fresh-frozen cadaveric specimens were tested at 0°, 30°, 60°, and 90° of knee flexion in the following states: 1) intact; 2) with resected ACL; 3) with resected ACL combined with anterolateral rotatory instability; 4) with an isolated ACLR; and 5) with combined ACLR + LET. The specimens were examined under various external loads: 1) unloaded; 2) with an anterior tibial translation force (ATF) of 98 N; 3) with an internal tibial torque (IT) of 5 Nm; and 4) with a combined internal tibial torque of 5 Nm and an anterior tibial translation force of 98 N (IT + ATF). The graft forces of the ACLR and LET were recorded by load cells incorporated into custom devices, which were screwed into the femoral tunnels. Motion of the knee joint was analysed using a 3D camera system. Results During IT and IT + ATF, the addition of a LET reduced the ACLR graft forces up to 61% between 0° and 60° of flexion (P = 0.028). During IT + ATF, the LET graft forces reached 112 N. ACLR alone did not restore native internal tibial rotation after combined ACL deficiency and anterolateral rotatory instability. Combined ACLR + LET was able to restore native internal tibial rotation values for 0°, 60° and 90° of knee flexion with decreased internal tibial rotation at 30° of flexion. Conclusion The study demonstrates that the addition of a LET decreases the forces seen by the ACLR graft and reduces residual rotational laxity after isolated ACLR during internal tibial torque loading. Due to load sharing, a LET could support the ACLR graft and perhaps be the reason for reduced repeat rupture rates seen in clinical studies. Care must be taken not to limit the internal tibial rotation when performing a LET.

Reconstrução combinada do ligamento cruzado anterior (RLCA) e tenodese extra-articular lateral pela técnica de Lemaire modificada versus RLCA isolada: Uma metanálise dos resultados clínicos

“…1). Among the ten remaining studies, two did not have a primary outcome (success rate), 12,15 one included skeletally- immature patients, 16 and one did not have adequate control. 17 In the end, we found five studies [18][19][20][21][22] eligible for qualitative and quantitative analysis after the searching strategies were applied.…”

“…1 ). Entre os dez estudos restantes, dois não tinham um resultado primário (taxa de sucesso), 12 15 um estudo 16 incluiu pacientes esqueleticamente imaturos e outro 17 não tinha controle adequado. Por fim, encontramos cinco estudos 18 19 20 21 22 elegíveis para as análises qualitativa e quantitativa após a aplicação das estratégias de busca.…”

“…A cohort study by Cavaignac et al 11 reported that ACLR with LET showed better graft maturity on magnetic resianace imaging (MRI) scans after one year of the procedures. Mayr et al 12 focused on the modified Lemaire technique, which has recently been used to perform LET, and they showed that it may decrease the strain on the graft as well as residual rotational laxity, thus improving the clinical outcomes. Therefore, we conducted a meta-analysis to determine the impact of ACLR and LET through the modified Lemaire technique compared with ACLR on patients with ACL rupture in terms of the rerupture rate and clinical outcome.…”

“…Um estudo de coorte realizado por Cavaignac et al 11 mostrou que a RLCA com TEL apresentou melhor maturidade do enxerto em exames de ressonância magnética (RM) após um ano do procedimento. Mayr et al 12 concentraram-se na técnica de Lemaire modificada, que foi recentemente realizada na TEL, e mostraram que ela pode diminuir a tensão no enxerto e a frouxidão rotacional residual, melhorando assim os resultados clínicos. Portanto, realizamos uma metanálise para determinar o impacto da RLCA e da TEL com a técnica de Lemaire modificada em comparação com a RLCA em pacientes com ruptura do LCA em termos de taxa de rerruptura e do resultado clínico.…”

Why Your Patient May Need an ACL Reconstruction Plus Lateral Extra-Articular Tenodesis Procedure

“…There has been significant investigation into the biomechanical effects of the LET, with cadaveric studies generally supporting its use in conjunction with ACLR. [21][22][23] Studies have shown reduced anterolateral residual laxity, ACL graft force, and anterior tibial translation (ATT). 24,25 Further biomechanical studies have also investigated the utility of the LET + ACLR with a concurrent medial meniscectomy, 26 showing reductions in ATT and internal rotation.…”