Anterior cruciate ligament reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, lateral extra-articular procedures such as the modified Lemaire extra-articular tenodesis (LET) have been proposed to decrease failure rates, but knowledge on short-term rehabilitation, stiffness and isokinetic strength is limited. This study aimed to assess the short-term patient-reported outcomes (PROMs) and physical performance outcomes following ACLR with and without LET. A prospective study was performed among 152 patients aged 25 years undergoing hamstring autograft ACLR with or without modified Lemaire LET between 2019 and 2022 with minimum 1-year follow-up. PROMs (Tegner, International Knee Documentation Committee, Lysholm, NRS for pain, and EQ-5D) were compared between groups preoperatively and at 3, 6, 9, 12 and 24 months, while physical performance (range-of-motion (ROM), and limb symmetry indices (LSI) of isokinetic testing, single-leg and timed-6m hop) was compared up to 9 months postoperatively. Baseline characteristics and outcomes were similar, except thicker grafts in the LET group (8.9 vs 8.7 mm, p=.047). At 3 months, Lemaire patients reported less pain (NRS pain 17.1 vs 35.6, p<.001), but at 6 months, Lemaire patients had inferior LSI for timed-6m hop (87% vs 96%, p=.003). At 9 months, Lemaire patients had similar return-to-sports, PROMs, and ROM, but had lower LSI for flexion endurance strength (88% vs 97%, p=.041). At 12 months, no differences were seen in PROMs. Patients undergoing ACLR with LET had less pain at 3 months, but worse LSI for timed-6m hop at 6 months and worse LSI for flexion endurance strength at 9 months. Both groups showed similar performance on all other outcomes, indicating that ACLR with LET is not associated with increased stiffness, complications or significant strength deficits. Level II prospective study.
List et al. (Mon,) studied this question.