Revision anterior cruciate ligament reconstruction in patients with high-grade anterolateral knee instability combined with modified Lemaire tenodesis using soft anchor fixation: Clinical and radiographic outcomes at two-year follow-up.

Abstract

In recent years, the number of primary anterior cruciate ligament reconstructions (ACLRs) has increased, accompanied by an increase in revision anterior cruciate ligament reconstructions (RACLRs). Residual anterolateral knee instability has been identified as a major contributor to graft failure. Consequently, lateral extra-articular procedures (LEAPs), particularly modified Lemaire tenodesis, have gained interest in the management of high-grade anterolateral rotational instability in RACLR. The aim of this study was to evaluate the clinical outcomes of patients undergoing combined RACLR and modified Lemaire tenodesis with soft anchor fixation. The hypothesis was that this fixation could lead to good results in terms of clinical outcomes at a minimum follow-up of two years. A retrospective review of consecutive patients with failed primary ACLR and high-grade anterolateral rotational instability (side-to-side difference >5 ​mm, pivot shift ≥2+) was performed. All patients underwent an outside-in femoral tunnel technique for doubled semitendinosus and gracilis tendon ACLR, and a 2.6-mm knotless suture anchor was used for Lemaire fixation. Postoperative rehabilitation allowed for immediate weight bearing and progressive range of motion. Patients were evaluated clinically and radiographically at 3 and 6 weeks and at 3, 6, 12, and 24 months. Outcome measures included Lachman and pivot-shift tests, Rolimeter measurements, Tegner Activity Scale, Lysholm score, and subjective and objective International Knee Documentation Committee (IKDC) scores. Also, radiographic analysis was performed at the last follow-up. The final population comprised 15 patients. At a minimum of 2 years' follow-up, one patient (6.6%) experienced graft failure. Most patients (10/15) achieved normal (Grade A) IKDC objective scores, with significant improvements in side-to-side differences and patient-reported outcomes. No intraoperative tunnel convergence was observed, and no additional hardware removal or reoperation was required. A combined RACLR with modified Lemaire extra-articular tenodesis using soft anchor fixation provided favorable clinical and radiographic results in patients with high-grade anterolateral rotatory knee instability without significant complications. IV.