Journal of Orthopaedic Reports (Sep 2025)
A prospective study evaluating combined arthroscopic anterior cruciate ligament reconstruction and anterolateral extra-articular tenodesis in athletes
Abstract
Background: Anterior Cruciate ligament rupture is a common orthopaedic injury that requires singlebundle/double-bundle reconstruction to restore the normal kinematics of the knee joint. However, anterolateral laxity remains a frequently encountered problem in chronic injuries, even with successful ACL reconstruction. This has been attributed to the anterior asymmetrical translation of the lateral tibial plateau. Thus, additional augmentation of the anterolateral structures is necessary to correct the rotator instability along with ACL reconstruction. Methods: This prospective interventional study includes high-risk athletes, patients with 3+ pivot shift in ACL deficient knees, patients with hyperlaxity, and patients requiring revision ACL reconstruction due to clinical instability. A combined procedure of single-bundle ACL reconstruction and Lateral Extra-articular tenodesis using Lemaire's technique was employed. Post-op rehabilitation was started from day one with quadriceps strengthening exercises and gradual progressive knee bending on the couch. Closed chain exercises were started after two weeks and full weight bearing, cycling, light jogging, and squatting were initiated after six weeks. Return to the sport was allowed at six to nine months. Results: It was observed that this technique resulted in significant improvements in the Lysholm score (p<0.0001), mean subjective IKDC (p<0.0001), and Tegner Activity score progressively increased post-operatively. Further, in subsequent follow-ups, the majority of patients (94.4%) were pivot shift negative, and functional outcomes were excellent to good. Conclusion: The study concluded that this combined procedure significantly increased the functional outcome scores and substantiated the possibility of a return to sport by providing additional rotational stability.
