How to Avoid Knee Tunnel Convergence When Performing a Modified Lemaire Extra-Articular Tenodesis.
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ABSTRACT:
SUBMITTER: Hopper GP
PROVIDER: S-EPMC9244758 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Recent literature has identified a population of active adolescents aged 13 to 15 years who are at high risk for anterior cruciate ligament graft rupture. Addressing the anterolateral complex during primary anterior cruciate ligament reconstruction has recently re-emerged in the literature, with various techniques available. This paper aims to describe a lateral extra-articular tenodesis procedure using the iliotibial band with a modified Lemaire technique. This procedure is recommended for active adolescents at a high risk of graft re-tear as an enhancement to primary anterior cruciate ligament reconstruction with soft-tissue graft.
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Project description:Increasing emphasis in the literature is recently being put on controlling rotational stability in patients with an anterior cruciate ligament rupture by addressing the anterolateral complex during anterior cruciate ligament reconstruction. Many different techniques for lateral extra-articular tenodesis have been described, with the (modified) Lemaire technique being widely favored. Recent literature does report that lateral extra-articular tenodesis leads to a reduction in persistent rotatory laxity and graft rupture rate, but also may be associated with increased pain, reduced quadriceps strength, reduced subjective functional recovery, and cosmetic complaints. Thus this article aims to describe our minimally invasive technique for a modified Lemaire tenodesis.
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Project description:A technique for lateral extra-articular tenodesis using proximal staple fixation is described as an adjunct to anterior cruciate ligament (ACL) reconstruction. Lateral extra-articular tenodesis has been used in an effort to decrease failure rates in ACL-deficient patients with ligamentous laxity, prior failed ACL surgery, or grade 3 pivot-shift findings. Numerous surgeons have described combining ACL reconstruction with extra-articular surgery. The approach described in this article is easy and cost-effective. Moreover, because this technique uses a staple instead of a SwiveLock (Arthrex, Naples, FL) or other suture anchor, it limits the chance of conflicting with the tunnels for the ACL because there is no need to drill or punch additional tunnels.
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Project description:The goal of this study was to report a surgical technique used in a revision anterior cruciate ligament (ACL) reconstruction case, consisting of an adaptation of the anterolateral iliotibial band tenodesis technique (modified Lemaire technique) combined with ACL reconstruction using an adjustable fixation mechanism. Rotational overload was one of the most likely hypotheses for failure of primary surgery, despite correct positioning and secure fixation. We performed a review of the most pertinent factors related to ACL reconstruction failure, as well as surgical strategies for its treatment. After this, we described, step by step, a combination of the 2 forms of surgical intervention that were already presented isolated with good clinical results, correcting the common anterior and rotational instabilities found in these cases. Knowing new techniques for intra- and extra-articular ligament reconstruction is imperative in the present day, when more patients are seeking a full return to their preinjury recreational, labor, and sports activities. We believe that the combination of these surgical techniques is able to achieve these goals effectively and reproducibly.
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Project description:In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some patients, however, have ongoing instability or suffer graft rupture. Failure after ACL reconstruction is multifactorial, but residual anterolateral rotatory laxity is 1 potential contributing factor. Lateral extra-articular procedures are a heterogenous group of operations that were initially described as isolated treatments for the ACL deficient knee, and subsequently used in combination with intra-articular reconstructions. Initial observational studies were encouraging, however, comparative studies were less flattering and lead to a general abandonment of these procedures. With improved understanding of the anatomy and biomechanics of the anterolateral capsuloligamentous complex there has been a renewed interest in these procedures. Recent systematic reviews suggest efficacy of these procedures in improving rotational control, though data showing improved patient reported outcomes or reduced graft rupture rates are lacking. Preliminary results from ongoing clinical trials are supportive for lateral extra-articular tenodesis when used as an augment to modern, intra-articular ACL reconstructions in targeted, high-risk patients.
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Project description:Anterolateral rotational instability may persist after anterior cruciate ligament (ACL) reconstruction for a variety of reasons including damage to lateral or posterolateral structures, injury to the meniscus, disruption of anterolateral soft tissue structures, or increased tibial slope. In the setting of revision or primary ACL reconstruction with persistent anterolateral laxity, despite repair or reconstruction of other injured structures or in the setting of increased tibial slope, a lateral extra-articular tenodesis procedure can be used to augment an ACL reconstruction to aid in restoring anterolateral rotational stability and to upload the ACL reconstruction graft. This article details our technique for performing a modified Lemaire lateral extra-articular tenodesis using iliotibial band autograft as an adjunct to ACL reconstruction.
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Project description:The main goal in anterior cruciate ligament reconstruction (ACLR) should be to restore normal knee biomechanics so the chances of failure decrease. The persistence of knee instability after ACLR goes from 0.7% to 20%. Several factors have been identified and studied, but there are some selected cases in which it seems that without adding lateral extra-articular tenodesis (LET) it is not possible to control rotational instability. Data exist supporting that LET could reduce pivot shift (PS), without losing flexion/extension range of motion nor adding risk of osteoarthritis. Recently, LET has been used in addition to ACLR to add restriction to internal tibial rotation forces, and different authors have shown their techniques to achieve this task. Also, biomechanical studies have compared different techniques for LET procedures. This article aims to describe our technique performing a modified Macintosh LET as an addition to ACLR in selected patients who require extra internal tibial rotation control. This is a reproducible, easy to learn, and inexpensive procedure in terms that only a high resistance suture is needed and not any other implant, such as a stapler, anchors, or screws, reducing the risk of tunnel coalition.
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