Clinical and functional outcomes of combined anterior cruciate ligament reconstruction and modified lemaire lateral extra-articular tenodesis in ACL-injured patients with generalized joint hypermobility: a minimum 2-year follow-up

Generalized joint hypermobility (GJH) significantly elevates the risk of graft failure following isolated anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to evaluate the clinical and functional outcomes of single-bundle ACLR using autologous hamstring tendons, combined with a modified Lemaire lateral extra-articular tenodesis (LET), in patients with GJH. A retrospective review was conducted on 25 patients with ACL ruptures and concomitant GJH who underwent combined single-bundle ACLR and modified Lemaire LET between January 2021 and October 2023. Knee stability was evaluated preoperatively and at the final follow-up using clinical examinations (Lachman, anterior drawer, and pivot-shift tests) and objective KT-1000 arthrometer side-to-side difference (SSD) measurements. Patient-reported functional outcomes were evaluated using Tegner activity, Lysholm, and International Knee Documentation Committee (IKDC) subjective scores, as well as the IKDC objective grading system. All 25 patients successfully completed a mean follow-up of 25.76 ± 1.42 months, with no major postoperative complications recorded. Postoperative MRI demonstrated satisfactory graft signal intensity and anatomical continuity, indicating stable graft integration at the final follow-up. At the final follow-up, passive knee hyperextension angle improved from + 7.80° ± 6.60° to + 6.30° ± 4.50° ( P = 0.046), and flexion improved from 127.00° ± 11.82° preoperatively to 135.60° ± 2.63° ( P = 0.001). Mildly positive (Grade I) residual laxity was observed in 4 patients for the Lachman test, 10 for the anterior drawer test, and 5 for the pivot-shift test. The KT-1000 SSD decreased significantly from 11.77 ± 1.80 mm preoperatively to 1.68 ± 1.25 mm at the final follow-up ( P < 0.001). Lysholm and IKDC scores increased from 55.48 ± 19.62 and 48.04 ± 8.41 preoperatively to 91.32 ± 4.89 and 86.12 ± 4.03 respectively ( P < 0.001). The final Tegner score was 5.12 ± 1.13, showing no statistically significant difference compared to the pre-injury level 5.44 ± 1.29 ( P = 0.382). In this preliminary, single-arm cohort of ACL-injured patients with concomitant GJH, combined single-bundle ACLR and modified Lemaire LET was associated with significant improvements in objective sagittal and rotational stability as well as patient-reported functional scores from baseline at short-term follow-up. However, comparative studies are needed to determine whether this combined approach yields superior outcomes compared to isolated ACL reconstruction.