Dulas Matthew, Vinod Amrit V, Athiviraham Aravind
The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
Department of Orthopaedic Surgery and Rehabilitation, The University of Chicago Medicine, Illinois, USA.
Video J Sports Med. 2023 Mar 28;3(2):26350254231155234. doi: 10.1177/26350254231155234. eCollection 2023 Mar-Apr.
In young patients, anterior cruciate ligament (ACL) reconstruction often results in graft failure. This may be due, in part, to concomitant injury to anterolateral complex (ALC) of the knee leading to rotatory laxity. The modified Lemaire lateral extra-articular tenodesis (LET) technique is intended to address the anterolateral rotatory instability due to injury to the ALC and to protect the ACL graft and meniscus.
The International Anterolateral Complex Consensus Group Meeting identified 4 appropriate indications for the modified Lemaire LET procedure: revision ACL, high-grade pivot shift, generalized ligamentous laxity/genu recurvatum, and young patients returning to pivoting activities.
The technique consists of harvesting an 8-cm long by 1-cm wide graft from the iliotibial band. The graft is released proximally and remains attached distally to Gerdy's tubercle. The graft is then passed deep to the lateral collateral ligament (LCL) from distal to proximal. The graft is then affixed to a point proximal and posterior to the lateral femoral epicondyle with an all-suture button. The graft is then tensioned with knee at 30° of flexion and neutral rotation, and then secured in place.
With the modified Lemaire LET, there was previously concern for overconstraint and lateral compartment degeneration. However, recent studies have shown that there is no increased risk for these complications with the LET procedure. The STABILITY trial found that the addition of LET to ACL reconstruction significantly reduces re-rupture and residual laxity when compared with ACL reconstruction alone. Moreover, the addition of LET to ACL reconstruction can restore native knee kinematics.
The addition of the modified Lemaire LET technique to traditional ACL reconstruction is a safe and effective adjunct that reduces the occurrence of graft rupture, addresses residual rotational laxity, and can restore native knee kinematics in appropriately indicated patient populations.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
在年轻患者中，前交叉韧带（ACL）重建术常常导致移植物失败。这可能部分归因于膝关节前外侧复合体（ALC）的伴随损伤，进而导致旋转松弛。改良的勒梅尔外侧关节外肌腱固定术（LET）旨在解决因ALC损伤导致的前外侧旋转不稳定，并保护ACL移植物和半月板。
国际前外侧复合体共识小组会议确定了改良勒梅尔LET手术的4个合适适应症：ACL翻修术、高级别轴移试验阳性、广泛性韧带松弛/膝反屈以及恢复旋转活动的年轻患者。
该技术包括从髂胫束获取一条长8厘米、宽1厘米的移植物。移植物近端松解，远端仍附着于Gerdy结节。然后将移植物从远端向近端穿过外侧副韧带（LCL）深部。接着用全缝线纽扣将移植物固定于股骨外侧髁近端和后方的一点。然后在膝关节屈曲30°且中立旋转位时对移植物进行张力调整，随后固定到位。
对于改良的勒梅尔LET手术，以前曾担心存在过度约束和外侧间室退变问题。然而，近期研究表明，LET手术并不会增加这些并发症的风险。STABILITY试验发现，与单纯ACL重建术相比，在ACL重建术中加用LET可显著降低再断裂和残余松弛的发生率。此外，在ACL重建术中加用LET可恢复膝关节的自然运动学。
在传统ACL重建术中加用改良的勒梅尔LET技术是一种安全有效的辅助方法，可减少移植物破裂的发生，解决残余旋转松弛问题，并能在合适的患者群体中恢复膝关节的自然运动学。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿发表包含患者的豁免声明或其他书面批准形式。
