AJSM Webinar Series - March 2022: Lateral Extraarticular Tenodesis (LET) in ACL-Reconstruction: From Past to Present-Revision Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Combined With Modified Lemaire Technique Versus Hamstring Graft Combined With Anterolateral Ligament Reconstruction

Revision Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Combined With Modified Lemaire Technique Versus Hamstring Graft Combined With Anterolateral Ligament Reconstruction

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The study compared two techniques for revision anterior cruciate ligament reconstruction (ACLR): bone-patellar tendon-bone (BPTB) graft combined with a modified Lemaire procedure and hamstring tendon (HT) graft with anterolateral ligament (ALL) reconstruction. The study aimed to determine whether the newer ALL reconstruction offers comparable clinical outcomes to the modified Lemaire procedure.<br /><br />A cohort of 72 patients, with 36 pairs matched based on various factors, was included. They underwent revision ACLR using either BPTB-Lemaire or HT-ALL, with a minimum follow-up of two years. Clinical outcomes, complications, knee laxity, return to sports, and various scores such as the Lysholm knee score and Tegner activity scale were assessed.<br /><br />Results showed that both methods had similar clinical efficacy, with no significant differences in knee laxity, return to sports, and most clinical scores. However, the Tegner activity scale score was higher in the BPTB-Lemaire group. There were no substantial differences in graft rupture or reoperation rates, although the BPTB-Lemaire group showed a higher graft rupture rate and reoperation rate trends. Surgical time was significantly shorter for HT-ALL.<br /><br />The study concluded that HT-ALL is at least as effective as the more traditional BPTB-Lemaire procedure for revision ACLR, making ALL reconstruction a safe and effective option. The study highlighted the efficacy of lateral extra-articular tenodesis (LET) in improving outcomes and reducing failure rates, which have been validated by other studies as well. There were minimal complications specific to either technique, affirming the safety profiles of both.<br /><br />The overall findings support the use of HT-ALL in revision ACLR, demonstrating it as a reliable alternative with shorter surgical times and comparable clinical outcomes. Further studies with larger samples and longer follow-up may bolster these conclusions and guide surgical practice.

Keywords

revision ACL reconstruction

BPTB graft

hamstring tendon graft

Lemaire procedure

ALL reconstruction

clinical outcomes

knee laxity

Tegner activity scale

surgical time

lateral extra-articular tenodesis