高度膝前外侧不稳患者的改良前交叉韧带重建联合改良Lemaire肌腱固定术软锚固定：两年随访的临床和影像学结果

IF 3.3 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-08-05 DOI:10.1016/j.jisako.2025.100938

Jacopo Conteduca , Alessandro Carrozzo , Marco Giaracuni , Paolo Pichierri , Damiano Longo , Giuseppe Rollo

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引用次数: 0

摘要

前言/目的：近年来，原发性前交叉韧带重建（ACLRs）的数量有所增加，同时ACLRs的翻修也有所增加。残留的膝关节前外侧不稳定被认为是移植物失败的主要原因。因此，外侧关节外手术（LEAPs），特别是改良Lemaire肌腱固定术，在ACLR翻修中对高度前外侧旋转不稳定的管理产生了兴趣。本研究的目的是评估接受改良ACLR和改良Lemaire肌腱固定术联合软锚固定的患者的临床结果。假设这种固定可以在至少两年的随访中获得良好的临床结果。方法：对原发性ACLR失败和高度前外侧旋转不稳定（侧侧差异bbb50 mm，枢轴移位≥2+）的连续患者进行回顾性分析。所有患者均采用由外至内的股骨隧道技术治疗双半腱肌和股薄肌腱ACLR，并使用2.6 mm无结缝合锚钉进行Lemaire固定。术后康复允许立即负重和进行性活动范围。在第3周和第6周以及第3、6、12和24个月时对患者进行临床和影像学评估。结果测量包括Lachman和pivot-shift测试、Rolimeter测量、Tegner活动量表、Lysholm评分以及主观和客观的国际膝关节文献委员会（IKDC）评分。最后一次随访时进行影像学分析结果：最终人群由15例患者组成。在至少2年的随访中，1例患者（6.6%）出现移植物衰竭。大多数患者（10/15）达到正常（A级）IKDC客观评分，侧对侧差异和患者报告的结果显着改善。术中未观察到隧道收敛，也不需要额外的硬体移除或再次手术。结论：ACLR联合改良Lemaire关节外肌腱固定术使用软锚固定为高度前外侧旋转性膝不稳患者提供了良好的临床和影像学结果，且无明显并发症。证据等级：四级。

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Revision anterior cruciate ligament reconstruction in patients with high-grade anterolateral knee instability combined with modified Lemaire tenodesis using soft anchor fixation: Clinical and radiographic outcomes at two-year follow-up

Introduction/objectives

In recent years, the number of primary anterior cruciate ligament reconstructions (ACLRs) has increased, accompanied by an increase in revision anterior cruciate ligament reconstructions (RACLRs). Residual anterolateral knee instability has been identified as a major contributor to graft failure. Consequently, lateral extra-articular procedures (LEAPs), particularly modified Lemaire tenodesis, have gained interest in the management of high-grade anterolateral rotational instability in RACLR. The aim of this study was to evaluate the clinical outcomes of patients undergoing combined RACLR and modified Lemaire tenodesis with soft anchor fixation. The hypothesis was that this fixation could lead to good results in terms of clinical outcomes at a minimum follow-up of two years.

Methods

A retrospective review of consecutive patients with failed primary ACLR and high-grade anterolateral rotational instability (side-to-side difference >5 mm, pivot shift ≥2+) was performed. All patients underwent an outside-in femoral tunnel technique for doubled semitendinosus and gracilis tendon ACLR, and a 2.6-mm knotless suture anchor was used for Lemaire fixation. Postoperative rehabilitation allowed for immediate weight bearing and progressive range of motion. Patients were evaluated clinically and radiographically at 3 and 6 weeks and at 3, 6, 12, and 24 months. Outcome measures included Lachman and pivot-shift tests, Rolimeter measurements, Tegner Activity Scale, Lysholm score, and subjective and objective International Knee Documentation Committee (IKDC) scores. Also, radiographic analysis was performed at the last follow-up.

Results

The final population comprised 15 patients. At a minimum of 2 years’ follow-up, one patient (6.6%) experienced graft failure. Most patients (10/15) achieved normal (Grade A) IKDC objective scores, with significant improvements in side-to-side differences and patient-reported outcomes. No intraoperative tunnel convergence was observed, and no additional hardware removal or reoperation was required.

Conclusions

A combined RACLR with modified Lemaire extra-articular tenodesis using soft anchor fixation provided favorable clinical and radiographic results in patients with high-grade anterolateral rotatory knee instability without significant complications.