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

PURPOSE: The purpose of this work was to develop the rationale for adding a lateral extra-articular tenodesis to an ACL reconstruction in a knee with an injury that included both the ACL and anterolateral structures, and to show the early clinical picture. METHODS: The paper includes a review of recent anatomical and biomechanical studies of the anterolateral aspect of the knee. It then provides a detailed description of a modified Lemaire tenodesis technique. A short-term clinical follow-up of a case and control group was performed, with two sequential groups of patients treated by isolated ACL reconstruction, and by combined ACL plus lateral tenodesis. RESULTS: The anatomical and biomechanical literature guide the surgeon towards a procedure based on the ilio-tibial band. The clinical study found a reduction in pivot-shift instability in the group of patients with the combined procedure. CONCLUSION: The evidence suggests that it should be appropriate to add a lateral extra-articular procedure to an ACL reconstruction in selected cases, but it was concluded that further data are required before definitive guidelines on the use of a lateral tenodesis can be established. LEVEL OF EVIDENCE: III.