Isolated lateral extra-articular tenodesis enhance better rotatory knee joint stability post-primary ACL repair: Four cases report and literature review

Introduction and importance: Residual rotatory instability has been reported to occur after primary anterior cruciate ligament reconstruction. The anterolateral ligament complex of the knee has gained attention for its role in rotational instability of the knee, especially in association with anterior cruciate ligament injuries. The role of an isolated lateral extra-articular tenodesis procedure among those patients presenting with residual rotatory instability after primary anterior cruciate ligament reconstruction has not been reported on. Case presentation: Four patients (Tegner level 4) presenting with residual rotatory instability after primary anterior cruciate ligament reconstruction without signs of graft failure, underwent an isolated lateral extra-articular tenodesis with modified Lemaire procedure. Pre- and postoperative outcome scores were assessed. At one-year follow-up, all patients reported functional knee stability. Pivot shift tests were negative and postoperative Lysholm scores were increased with a mean of 19.75 points. Tegner scores equaled the preinjury level. Clinical discussion: This case report showed that our four patients where successfully treated with an isolated secondary modified Lemaire procedure for residual anterolateral rotatory instability after primary anterior cruciate ligament reconstruction. Conclusion: An isolated secondary lateral extra-articular tenodesis procedure can be a valuable treatment option for moderate active patients with residual rotatory instability after a primary anterior cruciate ligament reconstruction without signs of graft failure