Purpose
To compare the biomechanical effects of femoral cortical surface fixation and intra-tunnel
fixation in modified Lemaire tenodesis on the restoration of native kinematics in
anterolateral structure–deficient knees.
Methods
Eight fresh-frozen cadaveric knees were mounted in a knee-customized jig to evaluate
anterior translation in anterior load and internal rotation degree in internal rotation
torque at 0°, 30°, 60°, and 90°, as well as anterolateral translation (ALT) in a simulated
pivot-shift test at 0°, 15°, 30°, and 45°. Kinematic tests were performed in the following
states: intact; anterolateral knee lesion (AL-Les); modified Lemaire lateral extra-articular
tenodesis (LET) with the femoral iliotibial band (ITB) strip fixed on the cortical
surface (cortical fixation), deep to the lateral collateral ligament (LCL) (deep LET-C);
and LET with the femoral ITB strip fixed into a tunnel (intra-tunnel fixation), deep
to the LCL (deep LET-IT) or superficial to the LCL (superficial LET-IT). The knee
kinematic changes in the AL-Les state and the 3 LET states were compared with each
other, with the intact state as the baseline.
Results
In the AL-Les state, the increased anterior translation instabilities were significantly
mitigated by the 3 LETs at 30°, 60°, and 90° (all P < .001), with overconstraint observed in both the deep LET-IT and superficial LET-IT
states at 60° (P = .047 and P < .001, respectively) and 90° (both P < .001). Similarly, the 3 LETs significantly reduced the internal rotation instabilities
in the AL-Les state at all flexion angles. The superficial LET-IT state overconstrained
the knee at 60° (P = .009) and 90° (P < .001) during internal rotation torque, and the deep LET-IT state did so at 60°
(P = .012). Furthermore, the ALT instabilities found in the AL-Les state were significantly
reduced by the 3 LETs during the simulated pivot-shift test. At 30° and 45°, these
LET states resulted in overconstraint when compared with the intact state, but the
superficial LET-IT state (P < .001) or deep LET-IT state (P = .016) presented a larger overconstraint than that in the deep LET-C at 45°, respectively.
Conclusions
The 3 Lemaire LET procedures evaluated reduced the anterior, internal rotational,
and ALT laxities in AL-Les knees and restored these parameters to the native baseline
of the intact state at most flexion angles. However, in deep flexion, some overconstraint
occurred in all LETs when compared with the intact state, of which the deep LET-C
state resulted in less overconstraint in anterior translation and internal rotation
than the deep LET-IT and superficial LET-IT states.
Clinical Relevance
This biomechanical study supports using the femoral cortical fixation technique to
fix the ITB strip in the modified Lemaire LET, which similarly improves knee kinematic
stability and causes less overconstraint compared with conventional intra-tunnel fixation.
These findings need more verification in clinical scenarios.
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 6,
2022
Received:
December 26,
2021
Footnotes
See commentary on page 3172
J.X., Y.Q., and K.H. contributed equally to this work.
The authors report the following potential conflicts of interest or sources of funding: This work was supported by the National Natural Science Foundation of China (81902186, 81671920, 31972923, and 81871753) and Natural Science Foundation of Shanghai (19ZR1438500). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2022 by the Arthroscopy Association of North America
