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. 2020 Oct 30;7(1):84.
doi: 10.1186/s40634-020-00302-1.

Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play

Leopold Joseph  1 , Guillaume Demey  1 , Thomas Chamu  2 , Axel Schmidt  3 , Alexandre Germain  2 , Floris van Rooij  4 , Mo Saffarini  5 , David Dejour  1
Affiliations

Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play

Leopold Joseph et al. J Exp Orthop. .

Abstract

Purpose: To determine whether isokinetic muscle recovery following ACLR using a hamstring tendon (HT) would be equivalent (non-inferior) in knees that had high-grade pivot-shift and adjuvant modified Lemaire procedure versus knees that had minimal pivot-shift and no adjuvant modified Lemaire procedure.

Methods: We evaluated 96 consecutive patients that underwent primary ACLR. Nine were excluded because of contralateral knee injury, and of the remaining 87, ACLR was performed stand-alone in 52 (Reference group), and with a Lemaire procedure in 35 (Lemaire group) who had high-grade pivot-shift, age < 18, or genu recurvatum > 20°. At 6 months, isokinetic tests were performed at 240°/s and 90°/s to calculate strength deficits of hamstrings (H) and quadriceps (Q). At 8 months, patients were evaluated using IKDC, Lysholm, and Tegner scores.

Results: Compared to the Reference group, the Lemaire group were younger (23.0 ± 2.5 vs 34.2 ± 10.5, p = 0.021) with a greater proportion of males (80% vs 56%, p < 0.001). The Lemaire group had no complications, but the Reference group had one graft failure and one cyclops syndrome. Strength deficits at 240°/s and at 90°/s were similar in both groups, but mixed H/Q ratios were lower for the Lemaire group (1.02 ± 0.19 vs 1.14 ± 0.24, p = 0.011). IKDC and Lysholm scores were similar in both groups, but Tegner scores were higher in the Lemaire group (median, 6.5 vs 6.0, p = 0.024).

Conclusions: ACLR with a modified Lemaire procedure for knees with rotational instability grants equivalent isokinetic muscle recovery as stand-alone ACLR in knees with no rotational instability. For ACL-deficient knees with high-grade pivot-shift, a Lemaire procedure restores rotational stability without compromising isokinetic muscle recovery.

Study design: Level III, comparative study.

Keywords: Anterior cruciate ligament reconstruction; Anterolateral complex; Isokinetic tests; Lemaire procedure; Pivot-shift.

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Conflict of interest statement

Dr. Dejour reports personal fees from SBM, during the conduct of the study.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
a The iliotibial band (ITB) was identified and incised to create a 10 mm × 80 mm strip originating from Gerdy’s tubercle (GT). b It was proximally sectioned, and whip stitched. c The ITB graft was then passed under the lateral collateral ligament (LCL), in a tunnel separate to that of the ACLR graft, at the isometric point. d The ITB graft was then fixed with an absorbable interference screw of a constant diameter of 7 mm
See this image and copyright information in PMC

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