Rotational knee instability, Extra articular technique

OBJECTIVES: The Associated Extra-Articular Technique (AET) with Lateral Tenodesis (LT) to the current techniques of intra-articular reconstruction of the Anterior Cruciate Ligament (ACL) could potentially improve the laxity of the knee and act synergically in controlling the phenomenon of the pivot displacement in cases of severe rotational instability. METHODS: Twenty-two consecutive patients were selected who met all the inclusion criteria and underwent reconstruction of the ACL with double bundle and AET between February 2012 and May 2013. The inclusion criteria in this study was the presence of moderate to severe rotational instability as revealed by a score of pivot test of 2 to 3 (on a scale ranging from 0 = negative, to 3 = subluxation). The least time between trauma and surgery was 3 months, and average age under 40 years old. RESULTS: The mean time of follow-up was 32.4 ± 3.9 months. In all cases, the Lysholm and IKDC test scores improved significantly (p <0.0001). The differential laxity above the average was 8 ± 1.9 mm before surgery and significantly reduced to 0.7 ± 0.8 mm at the last follow-up (p <0.0001). Prior to surgery, patients had a Grade 3 Pivot Shift according to the IKDC criteria. After surgery, 15 patients had turned to a negative Pivot (Grade 0), and 7 patients were Grade 1. CONCLUSION: The lateral extra-articular reconstruction is generally used to control the internal rotation laxity of the tibia, and we are convinced that the combination of the LT with the reconstruction of the double bundle LCA would reduce the rotational translation during the pivot test.