How to Avoid Knee Tunnel Convergence When Performing a Modified Lemaire Extra-Articular Tenodesis

Hopper, Graeme P.; Helou, Abdo El; Philippe, Corentin; Campos, João Pedro; Vieira, Thaïs Dutra; Sonnery‐Cottet, Bertrand

doi:10.1016/j.eats.2022.02.019

Cited by 9 publications

(8 citation statements)

References 11 publications

(17 reference statements)

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“…The technique utilized for lateral extra-articular tenodesis was previously described by Hopper in 2022. [7] Risk of tunnel convergence has been described in the literature with different LEAPs. Jaecker et al [9] described a high possibility of tunnel convergence when a combined ACLR and Lemaire [1] procedure was performed in a cadaveric study.…”

Section: Discussionmentioning

confidence: 99%

Modified Lemaire extra-articular tenodesis with soft anchors in patients with high-grade anterior knee instability undergoing revision anterior cruciate ligament reconstruction (ACLR)

Conteduca,

Giaracuni,

Pichierri

et al. 2024

Preprint

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Purpose: Additional lateral extra-articular procedures can reduce the risk of failure of primary anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to evaluate the clinical outcome of patients treated with modified Lemaire extra-articular tenodesis with soft anchors in combination with revision ACLR for combined ACL graft failure and high-grade anterior knee instability. Methods: Between 2020 and 2022, 15 patients with graft failure after primary ACLR and high-grade anterior knee instability who underwent revision ACLR and modified Lemaire extra-articular tenodesis with soft anchors were included in the retrospective study. High-grade anterior knee instability was defined as a high-grade pivot shift and side-to-side difference of more than seven millimetres in the Rolimeter® test. All patients underwent a standardized bilateral knee subjective and objective evaluation, which included a Rolimeter arthrometric evaluation and bilateral weightbearing anteroposterior radiographs in full extension and lateral views. Results: Subjective evaluation yielded a median score of 6 (range, 3-9) on the Tegner activity scale. The mean Lysholm score was 95 (SD=9.5), and the mean subjective IKDC 2000 score was 95.4 (SD=7.8). On clinical examination, twelve patients had a negative Lachman test result one patient had a positive Lachman test result with a firm endpoint, and another patient had a positive Lachman test result. One patient had a grade 1+ pivot shift. No signs of femoral tunnel convergence were observed. Conclusions: The results of our study show that the use of modified Lemaire extra-articular tenodesis with soft anchors during revision ACLR represents a valid option in patients with primary ACLR failure and high-grade anterior knee instability.

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Section: Discussionmentioning

confidence: 99%

Modified Lemaire extra-articular tenodesis with soft anchors in patients with high-grade anterior knee instability undergoing revision anterior cruciate ligament reconstruction (ACLR)

Conteduca,

Giaracuni,

Pichierri

et al. 2024

Preprint

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“…14 These tunnel conflicts can be avoided by drilling the LET tunnel under direct visualization of the femoral ACL tunnel or in strict accordance with certain knee flexion when placing the femoral ACL and LET tunnel. 16 However, the introduced anchor technique avoids this issue, as described recently, 10 especially when using a self-tapping anchor. A similar technique was reported before using a tenodesis screw.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction

Behrendt

Fahlbusch

Akoto

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: There is evidence on the clinical effectiveness of the Lemaire technique for lateral extra-articular tenodesis (LET) in patients undergoing revision anterior cruciate ligament reconstruction (ACLR), but the best fixation technique is unknown. Purpose: To compare the clinical outcomes of 2 fixation techniques after revision ACLR: (1) onlay anchor fixation, which would avoid tunnel conflict and physis injury, and (2) transosseous tightening and interference screw fixation. Pain at the area of LET fixation was also assessed. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective 2-center study of patients with first-time revision ACLR and either LET with anchor fixation (aLET) with a 2.4-mm suture anchor or LET with transosseous fixation (tLET). Outcomes at minimum 12-month follow-up were assessed with the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain at the LET fixation area, Tegner score, and anterior tibial translation (ATT). A subgroup analysis within the aLET group investigated passing the graft over or under the lateral collateral ligament (LCL). Results: In total, 52 patients were included (26 patients in each group); the mean ± SD follow-up was 13.7 ± 3.4 months. No statistically significant differences were detected between the groups with respect to patient-reported outcome scores, clinical examination, or instrumented testing (side-to-side difference in ATT at 30° of flexion; aLET, 1.5 ± 2.5 mm; tLET, 1.6 ± 1.7 mm). Clinical failure was detected in 1 patient with aLET and none with tLET. Subgroup analysis revealed a small, nonsignificant flexion deficit in knees in which the iliotibial band strand was passed under (n = 42) or over (n = 10) the LCL. No clinically relevant tenderness was detected at the area of LET fixation in any group (aLET, 0.6 ± 1.3; tLET, 0.9 ± 1.7; over the LCL, 0.2 ± 0.6; under the LCL, 0.9 ± 1.6). Conclusion: Onlay anchor fixation and transosseous fixation of the LET were equivalent with respect to outcome scores and instrumented ATT testing. Clinically, there were minor differences in passage of the LET graft over or under the LCL.

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“…Another important point is that, because LFND is normally associated with ACL injuries with a significant pivot shift, 4 ACL reconstruction, in these cases, will certainly benefit from the lateral extra-articular procedure addressing that rotatory instability. The modified Lemaire procedure 9 is a suitable technique to address severe anterolateral rotatory instability, and because it is an open procedure, there is an opportunity—with little additional morbidity—to directly access the lateral femoral condyle and perform a well-controlled subchondral reduction. Through this approach, it is easier to aim the bone tamps toward the lesion, and because this approach provides a direct lateral view of the condylar curvature, it allows one to reliably evaluate the quality of the reduction to recover the condyle’s native shape.…”

Section: Discussionmentioning

confidence: 99%

“…Preparation for modified Lemaire extra-articular tenodesis is performed prior to ACL reconstruction, as well as reduction of the LFND. An incision centered on the lateral epicondyle, as described for the modified Lemaire procedure, 9 is distally extended to allow a lateral arthrotomy suitable for this technique ( Fig 4 ). After a strip of the iliotibial band (ITB) is harvested from its middle third, the graft is whipstitched using a No.…”

Section: Surgical Techniquementioning

confidence: 99%

Reduction of a Depressed Femoral Lateral Notch at the Time of Lateral Extra-articular Tenodesis

Jácome Pacheco,

Hopper,

Giurazza

et al. 2023

Arthroscopy Techniques

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How to Avoid Knee Tunnel Convergence When Performing a Modified Lemaire Extra-Articular Tenodesis

Cited by 9 publications

References 11 publications

Modified Lemaire extra-articular tenodesis with soft anchors in patients with high-grade anterior knee instability undergoing revision anterior cruciate ligament reconstruction (ACLR)

Modified Lemaire extra-articular tenodesis with soft anchors in patients with high-grade anterior knee instability undergoing revision anterior cruciate ligament reconstruction (ACLR)

Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction

Reduction of a Depressed Femoral Lateral Notch at the Time of Lateral Extra-articular Tenodesis

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