Differences in clinical outcomes and rotational stability between anterolateral ligament reconstruction and Lemaire lateral tenodesis following primary anterior cruciate ligament reconstruction

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 University of California, Davis School of Medicine, Sacramento, CA, USA

4 Orthopedic & Rehabilitation Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

5 Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

10.22038/abjs.2025.84170.3826

Abstract

Abstract

Objectives: Residual instability after anterior cruciate ligament reconstruction (ACLR) is a common issue among young, active patients. Currently, two common methods are used to address this matter: Anterolateral ligament reconstruction (ALLR) by a graft or lateral extra-articular tenodesis (LET). We aim to compare the Lemaire method for LET versus ALL reconstruction in minimizing rotational instability after ACLR.

Methods: This retrospective cohort consisted of patients with ACL ruptures who had simultaneous arthroscopic ACLR and either Lemaire lateral tenodesis or ALL reconstruction between April 2013 and March 2021. Patients were re-examined at about 24 months post-operatively. We evaluated rotational instability using the Pivot shift test, and anterior stability by the KT-1000 test. Outcomes were measured by the Lysholm and International Knee Documentation Committee (IKDC) questionnaires.

Results: This study evaluated 53 patients who experienced ACLR with either Lemaire method for LET (n=24) or ALLR (n=29). No substantial variation was observed considering age, sex, body mass index (BMI), physiotherapy sessions, time from injury to surgery and the ACL graft diameter. Rotational stability was significantly better in the Lemaire group (16.7% vs. 82.8%, P < 0.001). Functional outcomes trended higher in the Lemaire group but were not statistically significant. Multivariate logistic regression revealed that the surgical technique was the only significant predictor of rotational instability, with ALLR patients 18.8 times more likely to experience a positive pivot shift (OR: 18.78, 95% CI: 4.34–81.18, P < 0.001).

Conclusion: This retrospective cohort study suggests that Lemaire lateral tenodesis could be more effective than ALL reconstruction in minimizing rotational instability after arthroscopic ACLR. Yet, there was no superiority in functional scores among groups.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 05 May 2025

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History

  • Receive Date: 03 December 2024
  • Revise Date: 10 March 2025
  • Accept Date: 22 January 2025

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