Differences in Clinical Outcomes and Rotational Stability Between Anterolateral Ligament Reconstruction and Lemaire Lateral Tenodesis Following Primary Anterior Cruciate Ligament Reconstruction.

Abstract

Residual instability following anterior cruciate ligament reconstruction (ACLR) is a common concern among young, active patients. Currently, two primary methods are used to address this matter: anterolateral ligament reconstruction (ALLR) using a graft and lateral extra-articular tenodesis (LET). This study aims to compare the Lemaire method for LET with ALLR in minimizing rotational instability after ACLR. This retrospective cohort study included patients with ACL ruptures who underwent simultaneous arthroscopic ACLR and either Lemaire lateral tenodesis or ALL reconstruction between April 2013 and March 2021. Patients were re-examined approximately 24 months post-operatively. We evaluated rotational instability using the pivot shift test, and anterior stability with the KT-1000 test. Outcomes were measured using the Lysholm and International Knee Documentation Committee (IKDC) questionnaires. This study evaluated 53 patients who underwent ACLR using either the Lemaire method for LET (n=24) or ALLR technique (n=29). No substantial differences were observed in terms of age, sex, body mass index (BMI), number of physiotherapy sessions, time from injury to surgery, or the diameter of the ACL graft. Rotational stability was significantly better in the Lemaire group (16.7% vs. 82.8%, P < 0.001). Although functional outcomes were higher in the Lemaire group, these differences were not statistically significant. Multivariate logistic regression analysis revealed that the surgical technique was the only significant predictor of rotational instability, with patients undergoing ALLR being 18.8 times more likely to experience a positive pivot shift (OR: 18.78, 95% CI: 4.34-81.18, P < 0.001). This retrospective cohort study suggests that Lemaire LET may be more effective than ALLR in minimizing rotational instability following arthroscopic ACLR. However, there was no superiority in functional scores between the groups.