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[Anterolateral stabilization using the modified Lemaire technique for ACL deficiency].

M Wurm1, E Herbst1, P Forkel1

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Summary

Anterolateral extra-articular reconstruction effectively treats persistent anterolateral knee instability after ACL reconstruction. This technique may also lower the re-rupture rate, offering good short-term patient outcomes.

Keywords:
AnterolateralExtraarticularJoint InstabilityKneeRotation

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomechanics

Background:

  • Persistent anterolateral knee instability often occurs after anterior cruciate ligament (ACL) reconstruction.
  • This instability can impact patient function, particularly in high-performance athletes or those with hyperlaxity.
  • Revision of non-anatomic ACL reconstructions may be necessary before addressing anterolateral instability.

Purpose of the Study:

  • To describe the surgical technique for anterolateral extra-articular reconstruction using an iliotibial band (ITB) graft.
  • To evaluate the effectiveness of this procedure in managing persistent anterolateral rotatory instability.
  • To compare anterolateral tenodesis with anterolateral ligament reconstruction.

Main Methods:

  • An extra-articular tenodesis using an ITB graft was performed.
  • The graft was passed under the lateral collateral ligament and fixed at an isometric point near the lateral femoral epicondyle.
  • Postoperative management included bracing for at least six weeks and controlled range of motion and weight-bearing.

Main Results:

  • Anterolateral extra-articular reconstruction can reduce persistent anterolateral rotatory instability and the rate of ACL re-rupture.
  • Patient-reported short-term outcomes were favorable.
  • Biomechanical data suggest anterolateral tenodesis may be superior to anterolateral ligament reconstruction, especially when the graft is fixed isometrically.

Conclusions:

  • Anterolateral extra-articular tenodesis is a viable option for persistent anterolateral knee instability post-ACL reconstruction.
  • Proper graft fixation at an isometric point is crucial to avoid excessive lateral compartment forces.
  • This procedure is indicated for high-grade pivot shifts, revision ACL reconstructions, and persistent instability after anatomic ACL reconstruction.