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Abstract：
OBJECTIVE: To determine whether isokinetic muscle recovery following ACLR using a hamstring tendon (HT) would be equivalent (non-inferior) in knees that had high-grade pivot-shift and adjuvant modified Lemaire procedure versus knees that had minimal pivot-shift and no adjuvant modified Lemaire procedure.
METHODS: We evaluated 96 consecutive patients that underwent primary ACLR. Nine were excluded because of contralateral knee injury, and of the remaining 87, ACLR was performed stand-alone in 52 (Reference group), and with a Lemaire procedure in 35 (Lemaire group) who had high-grade pivot-shift, age < 18, or genu recurvatum > 20°. At 6 months, isokinetic tests were performed at 240°/s and 90°/s to calculate strength deficits of hamstrings (H) and quadriceps (Q). At 8 months, patients were evaluated using IKDC, Lysholm, and Tegner scores.
RESULTS: Compared to the Reference group, the Lemaire group were younger (23.0 ± 2.5 vs 34.2 ± 10.5, p = 0.021) with a greater proportion of males (80% vs 56%, p < 0.001). The Lemaire group had no complications, but the Reference group had one graft failure and one cyclops syndrome. Strength deficits at 240°/s and at 90°/s were similar in both groups, but mixed H/Q ratios were lower for the Lemaire group (1.02 ± 0.19 vs 1.14 ± 0.24, p = 0.011). IKDC and Lysholm scores were similar in both groups, but Tegner scores were higher in the Lemaire group (median, 6.5 vs 6.0, p = 0.024).
CONCLUSIONS: ACLR with a modified Lemaire procedure for knees with rotational instability grants equivalent isokinetic muscle recovery as stand-alone ACLR in knees with no rotational instability. For ACL-deficient knees with high-grade pivot-shift, a Lemaire procedure restores rotational stability without compromising isokinetic muscle recovery.
METHODS: Level III, comparative study.
METHODS: We evaluated 96 consecutive patients that underwent primary ACLR. Nine were excluded because of contralateral knee injury, and of the remaining 87, ACLR was performed stand-alone in 52 (Reference group), and with a Lemaire procedure in 35 (Lemaire group) who had high-grade pivot-shift, age < 18, or genu recurvatum > 20°. At 6 months, isokinetic tests were performed at 240°/s and 90°/s to calculate strength deficits of hamstrings (H) and quadriceps (Q). At 8 months, patients were evaluated using IKDC, Lysholm, and Tegner scores.
RESULTS: Compared to the Reference group, the Lemaire group were younger (23.0 ± 2.5 vs 34.2 ± 10.5, p = 0.021) with a greater proportion of males (80% vs 56%, p < 0.001). The Lemaire group had no complications, but the Reference group had one graft failure and one cyclops syndrome. Strength deficits at 240°/s and at 90°/s were similar in both groups, but mixed H/Q ratios were lower for the Lemaire group (1.02 ± 0.19 vs 1.14 ± 0.24, p = 0.011). IKDC and Lysholm scores were similar in both groups, but Tegner scores were higher in the Lemaire group (median, 6.5 vs 6.0, p = 0.024).
CONCLUSIONS: ACLR with a modified Lemaire procedure for knees with rotational instability grants equivalent isokinetic muscle recovery as stand-alone ACLR in knees with no rotational instability. For ACL-deficient knees with high-grade pivot-shift, a Lemaire procedure restores rotational stability without compromising isokinetic muscle recovery.
METHODS: Level III, comparative study.
摘要：
目的：为了确定使用腿筋肌腱（HT）的ACLR后的等速肌恢复在具有高级枢轴移位和辅助改良Lemaire程序的膝盖中是否等效（非下位）与具有最小枢轴移位和无辅助改良Lemaire程序的膝盖。
方法：我们评估了96例接受原发性ACLR的连续患者。九人因为对侧膝盖受伤被排除在外，在其余87例中，ACLR在52例（参考组）中单独进行，35名（勒梅尔组）的勒梅尔程序进行了高级枢轴转换，年龄<18岁，或Genurecurvatum>20°。6个月时,在240°/s和90°/s下进行等速运动测试，以计算腿筋（H）和股四头肌（Q）的强度不足。8个月时,患者使用IKDC进行评估，Lysholm,和Tegner得分。
结果：与参考组相比，Lemaire组年轻（23.0±2.5vs34.2±10.5，p=0.021），男性比例更高（80％vs56％，p<0.001)。Lemaire组无并发症,但参考组有1例移植失败和1例眼管综合征。两组在240°/s和90°/s时的强度缺陷相似，但是Lemaire组的混合H/Q比率较低（1.02±0.19vs1.14±0.24，p=0.011）。两组的IKDC和Lysholm评分相似，但勒梅尔组的Tegner得分较高(中位数，6.5vs6.0，p=0.024）。
结论：对于旋转不稳定的膝盖，采用改良Lemaire手术的ACLR可在没有旋转不稳定的膝盖中获得与独立ACLR相当的等速肌恢复。对于缺乏ACL的膝盖，带有高级枢轴移位，Lemaire程序可恢复旋转稳定性，而不会影响等速肌恢复。
方法：三级，比较研究。
方法：我们评估了96例接受原发性ACLR的连续患者。九人因为对侧膝盖受伤被排除在外，在其余87例中，ACLR在52例（参考组）中单独进行，35名（勒梅尔组）的勒梅尔程序进行了高级枢轴转换，年龄<18岁，或Genurecurvatum>20°。6个月时,在240°/s和90°/s下进行等速运动测试，以计算腿筋（H）和股四头肌（Q）的强度不足。8个月时,患者使用IKDC进行评估，Lysholm,和Tegner得分。
结果：与参考组相比，Lemaire组年轻（23.0±2.5vs34.2±10.5，p=0.021），男性比例更高（80％vs56％，p<0.001)。Lemaire组无并发症,但参考组有1例移植失败和1例眼管综合征。两组在240°/s和90°/s时的强度缺陷相似，但是Lemaire组的混合H/Q比率较低（1.02±0.19vs1.14±0.24，p=0.011）。两组的IKDC和Lysholm评分相似，但勒梅尔组的Tegner得分较高(中位数，6.5vs6.0，p=0.024）。
结论：对于旋转不稳定的膝盖，采用改良Lemaire手术的ACLR可在没有旋转不稳定的膝盖中获得与独立ACLR相当的等速肌恢复。对于缺乏ACL的膝盖，带有高级枢轴移位，Lemaire程序可恢复旋转稳定性，而不会影响等速肌恢复。
方法：三级，比较研究。
