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J Knee Surg
DOI: 10.1055/a-2712-4279
Original Article

Short-term Outcomes and Rehabilitation Following Anterior Cruciate Ligament Reconstruction with and without Lateral Extra-articular Tenodesis in Younger Patients: A Prospective Comparison

Authors

  • Jelle P. van der List 

    1   Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
    2   Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University, Columbus, Ohio, United States
    3   Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, United States

  • Ingmar F. Blom

    1   Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
    4   Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands

  • Dirk Jan Hofstee

    4   Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands

  • Freerk J. Jonkers

    4   Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands

  • Joyce L. Benner

    1   Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
    4   Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
    5   Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands

Funding Information This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Anterior cruciate ligament reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, lateral extra-articular procedures such as the modified Lemaire extra-articular tenodesis (LET) have been proposed to decrease failure rates, but knowledge on short-term rehabilitation, stiffness, and isokinetic strength is limited. This study aimed to assess the short-term patient-reported outcome measures (PROMs) and physical performance outcomes following ACLR with and without LET. A prospective study was performed among 152 patients aged ≤25 years undergoing hamstring autograft ACLR with or without modified Lemaire LET between 2019 and 2022 with minimum 1-year follow-up. PROMs (Tegner, International Knee Documentation Committee, Lysholm, NRS for pain, and EQ-5D) were compared between groups preoperatively and at 3, 6, 9, 12, and 24 months, while physical performance (range of motion [ROM], and limb symmetry indices [LSI] of isokinetic testing, single-leg and timed-6m hop) was compared up to 9 months postoperatively. Baseline characteristics and outcomes were similar, except thicker grafts in the LET group (8.9 vs. 8.7 mm, p = 0.047). At 3 months, Lemaire patients reported less pain (NRS pain 17.1 vs. 35.6, p < .001), but at 6 months, Lemaire patients had inferior LSI for timed-6m hop (87% vs. 96%, p = 0.003). At 9 months, Lemaire patients had similar return to sports, PROMs, and ROM, but had lower LSI for flexion endurance strength (88% vs. 97%, p = 0.041). At 12 months, no differences were seen in PROMs. In conclusion, Patients undergoing ACLR with LET had less pain at 3 months, but worse LSI for timed-6m hop at 6 months and worse LSI for flexion endurance strength at 9 months. Both groups showed similar performance on all other outcomes, indicating that ACLR with LET is not associated with increased stiffness, complications, or significant strength deficits.

Level of evidence: Level II prospective study.

Keywords

anterior cruciate ligament - reconstruction - lateral extra-articular procedure - anterolateral ligament - modified Lemaire tenodesis

Note

This study was performed at: Centre for Orthopaedic Research Alkmaar (CORAL) and the Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands.




Publication History

Received: 18 March 2025

Accepted: 26 September 2025

Accepted Manuscript online:
29 September 2025

Article published online:
14 October 2025

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