Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis in patients at high risk of rotational instability

M. Mahabubul Hussain; Mohammad Mahsin; Jannat Ul Alam Jisa; M. Tareq Anwar Shishir; Tahmina Afroze; M. Rakiz Khan; Mohammad Mohsin Mia

doi:10.18203/issn.2455-4510.IntJResOrthop20263898

Authors

M. Mahabubul Hussain Department of Sports Medicine and Arthroscopy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
Mohammad Mahsin Department of of Orthopedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Jannat Ul Alam Jisa Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh
M. Tareq Anwar Shishir Department of Sports Medicine and Arthroscopy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
Tahmina Afroze Department of Skin & Venereology, Enam Medical College, Savar, Bangladesh
M. Rakiz Khan Department of Sports Medicine and Arthroscopy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
Mohammad Mohsin Mia Department of Ilizarov & Deformity Correction, National Institute of Traumatology & Orthopedic Rehabilitation, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263898

Keywords:

Anterior cruciate ligament reconstruction, Lateral extra-articular tenodesis, Modified Lemaire technique, Pivot-shift test, Rotational instability

Abstract

Background: Despite advances in anterior cruciate ligament (ACL) reconstruction, residual rotational instability and graft failure remain concerns, particularly in high-risk patients. Lateral extra-articular tenodesis (LET) may improve rotational control and protect the ACL graft. To evaluate clinical outcomes of combined ACL reconstruction and LET using a modified Lemaire technique in patients at high risk of rotational instability.

Methods: This prospective observational study included 30 patients with primary ACL rupture and high-grade (grade 2 or 3) pivot shift treated at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, from July 2022 to June 2025. All underwent arthroscopic ACL reconstruction combined with modified Lemaire LET. Functional outcomes were assessed using IKDC and Lysholm scores, while knee stability was evaluated by pivot-shift and Lachman tests. Preoperative and final follow-up outcomes were compared, with p<0.05 considered statistically significant.

Results: Mean age was 25.8±6.4 years and 66.7% were male. Mean IKDC score improved from 52.6±9.8 to 87.3±7.4 and Lysholm score from 58.9±10.6 to 91.2±6.8 (both p<0.001). At final follow-up, 86.7% had negative pivot-shift and 80.0% negative Lachman tests. Good-to-excellent outcomes were achieved in 86.7% by IKDC and 90.0% by Lysholm criteria. Overall, 83.3% returned to sports or previous activity and graft failure occurred in 3.3%.

Conclusions: Combined ACL reconstruction with modified Lemaire LET provided favorable functional recovery, improved knee stability and low graft failure, supporting its use in appropriately selected high-risk patients.

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