The scientific rationale for lateral tenodesis augmentation of intra-articular ACL reconstruction using a modified ‘Lemaire’ procedure

Abstract

4Purpose: The purpose of this work was to develop the rationale for adding a lateral extra-5 articular tenodesis to an ACL reconstruction in a knee with an injury that included both the 6 ACL and anterolateral structures, and to show the early clinical picture. 7Methods: The paper includes a review of recent anatomical and biomechanical studies of 8 the anterolateral aspect of the knee. It then provides a detailed description of a modified 9Lemaire tenodesis technique. A short-term clinical follow up of a case and control group was 10 performed, with two sequential groups of patients treated by isolated ACL reconstruction, and 11 by combined ACL plus lateral tenodesis. 12

Editorial Commentary: The Anterolateral Ligament: The Emperor's New Clothes?

“…In the laboratory setting, this is very effective, 3 and early clinical results have shown a significant improvement in reducing abnormal pivot shift on clinical examination from 9% to 2%. 19 In addition, no loss of range of motion was detected in the patients at early follow-up. 19 Because there are no long-term follow-up results, however, it pays to be cautious about such procedures.…”

“…We continue with our laboratory work as various techniques need to be tested to find the optimal option. I currently undertake a modified Lemaire-type procedure 19 using a strip of ITB left attached to the Gerdy tubercle and taken deep to the LCL. It is then attached 10 mm proximal and 5 mm posterior to the LCL attachment to the femur (Fig 4).…”

Author Reply to Letters to the Editor From Sonnery-Cottet et al. and Ferretti

“…I did make that weakness clear in the article. 12 Those results pale in contrast to the impressive contribution from Sonnery-Cottet et al, 13 which, as they state, is award-winning.…”

“…My preference for a lateral extra-articular tenodesis is based on such studies from our laboratory showing superior efficacy with a lateral extra-articular tenodesis procedure. [10][11][12] I dispute the contention that I have "aggressively" promoted any procedure. I have simply stated my current preference at this moment in time.…”

Letters to the Editor Highlight Current Controversies

“…In response to the well-performed study by Monaco, Fabbri, Mazza, Daggett, Redler, Lanzetti, De Carli, and Ferretti titled "The Effect of Sequential Tearing of the Anterior Cruciate and Anterolateral Ligament on Anterior Translation and the Pivot-Shift Phenomenon: A Cadaveric Study Using Navigation," 5 Mr. Andy Williams of London, England offered the Editorial Commentary, "The Anterolateral Ligament: The Emperor's New Clothes?" 6 Of note, Williams' bonafides include content expertise, 7 and in private discussion, one of our editors commented that he learned "more about the anterolateral side of the knee from Andy Williams' commentary than from any other article or lecture he had read or heard on the topic. "…”