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Modified Lemaire Antero-Lateral Extra Articular Tenodesis Alters the MRI Maturity Signal of ACL Hamstring Graft

Modified Lemaire Antero-Lateral Extra Articular Tenodesis Alters the MRI Maturity Signal of ACL Hamstring Graft

Maximiliano Ibañez, MD, SPAIN Gonzalo Rojas Castillo, MD, CHILE Simone Perelli, MD,PhD, SPAIN Pablo E. Gelber, MD, PhD, SPAIN Juan Ignacio Erquicia, MD, SPAIN Àngel Masferrer-Pino, MD PhD, SPAIN Daniel Pérez-Prieto, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN

ICATME - Dexeus University Hospital, Barcelona, Barcelona, SPAIN

2021 Congress   ePoster Presentation     rating (1)


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Summary: Modified Lemaire antero-lateral extra articular tenodesis alters the MRI maturity signal of ACL hamstring graft.


One of the most widespread procedure to restore anterolateral stability is the lateral extra-articular tenodesis (LET). Clinical outcomes after association of a LET to ACL reconstruction (ACL-R) have been widely investigated, however potential influence of LET over the ACL ligamentization process have not been taken in account yet.


To compare on a 10 months postoperatively MRI, the maturity of the grafts after ACL hamstring autograft reconstruction associated or not with a LET.
The hypothesis was that when modified Lemaire LET (MLLET) is performed, the MRI parameters of ACL graft maturity are modified.

Study Design:
Retrospective comparative cohort study


Patients who had undergone an anatomic ACL-R combined or not with MLLET and had had MRIs 10 months postoperatively from December 2017 to December 2018 were included.
30 isolated ACL-R and 22 ACL-R plus MLLET were included. The two groups were comparable based on all the criteria analyzed.
To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in three regions of interest (ROIs) of the proximal, mid-substance and distal ACL graft. Lower SNQ ratios indicate less water content and theoretically better maturity and healing of the graft.


The mean SNQ was 4.62 (SD 4.29; range 3.12-6.19) for the isolated ACL-R group and 7.59 (SD 4.68; range 4.38-8.04) in the ACL plus MLLET (P = 0.012).
Upon comparing the mean values of the three portions of one group to those of the other group, we found that only at the proximal and middle portions was there a significant difference between the 2 groups (p=0.007 and p=0.049, respectively) while no differences were identified (p=0.369) in the distal third.


At the 10-month follow-up, hamstring tendon autografts for anatomic ACL reconstruction associated with MLLET do not show the same MR signal intensity compared to an isolated hamstring anatomic ACL reconstruction.

Keywords: ACL reconstruction; ligamentization; lateral extra-articular tenodesis. graft incorporation.