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Mid-Term Results of Anterior Cruciate Ligament Reconstruction with Anterolateral Augmentation, Lemaire Tenodesis, in Soccer Players. Functional Results and Return to Play

Mid-Term Results of Anterior Cruciate Ligament Reconstruction with Anterolateral Augmentation, Lemaire Tenodesis, in Soccer Players. Functional Results and Return to Play

Pedro Alvarez-Diaz, MD, PhD, Prof., SPAIN Enrique Pavez, MD, CHILE Gilbert Steinbacher, MD, SPAIN Eduard Alentorn-Geli, MD, PhD, MSc, FEBOT, FACGME, SPAIN David Barastegui, MD, PhD, MSc, SPAIN Jorge Ramirez Haua, MD, SPAIN Maria Victoria Pomenta, MD, SPAIN Esther Sala, MD, SPAIN Sebatian Grossi, MD, SPAIN Aleix Pons Bartroli, MD , SPAIN Patricia Laiz Boada, BSc, SPAIN Ramon Cugat Bertomeu, MD, PhD, SPAIN

Instituto Cugat. Hospital Quiron Barcelona. Mutualidad de Futbolistas Españoles.UIC-Barcelona, Barcelona, Barcelona, SPAIN


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Summary: ACL revision surgery with modified Lemaire-type tenodesis is a procedure that restores knee stability in a high percentage, with excellent functional results, allowing a return to professional and semi-professional football, without further objective functional deterioration.


Introduction

Rotational instability associated with anterior cruciate ligament (ACL) injuries is a common decompensating factor in knee stability. The rate of persistence of rotational instability, measured by Pivot Shift, is a frequent cause of stress and is usually associated with surgery failure. Previous anatomical and biomechanical studies have shown the important role of anterolateral structures in rotational stability 2-3 . Although management techniques for anterolateral structures are indicated in the context of rotational instability, few studies have documented their results.

Purpose

To describe our results in a period of 6 years with (2015-20) a minimum follow-up of 2 years, regarding the use of anterolateral augmentation (LET) with Lemaire-type tenodesis associated with revision ACL Reconstruction. In terms of functional results and sports return.
Study Design: Case series; Level of evidence, 4.

Material And Methods

We evaluated the functional results and sporting return of 51 patients operated on over a period of 6 years( 2015-2020) at the Mutualidad del Futbolistas Españoles. These patients underwent ACL revision reconstruction using the HTH autograft contralateral in 25 cases and Bone-Aquiles tendon in 26 technique with modified Lemaire-type anterolateral augmentation (LET), according to the previously published technique.The primary outcome was the clinical result measured by a validated instrument: the Tegner-Lysholm Scale. And as a secondary outcome, return to sports was taken, evaluated by means of the Sports Return After Injury scale (ACL RSI).Patients who did not complete follow-up or who underwent other lower extremity interventions during this period were excluded.

Results

Most of the patients (50 of 51) presented an excellent result on the Tegner-Lysholm functional scale, only one patient presented a score compatible with a good result (89 points). This demonstrates the excellent functional results of surgery in the medium term. All were able to return to their activities of daily living. No differen are findindg betwen boht groups. Regarding sports reintegration, the Post Injury Return Scale (ACL RSI) showed excellent results in most patients with results greater than 90%. However, when asked if they still played soccer, 18 patients no longer practiced that sport for reasons unrelated to the injury.

Conclusions

ACL revision surgery with modified Lemaire-type tenodesis is a procedure that restores knee stability in a high percentage, with excellent functional results, allowing a return to professional and semi-professional football, without further objective functional deterioration.
Keywords: Modified Lemaire technique ( LET); Revision ACL; sports injury; soccer


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