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

Abstract 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.