Functional Outcomes in the Management of ACL Rupture by ACL Reconstruction with Lateral Extra-articular Tenodesis Lemaire Procedure Versus MacIntosh Procedure: A Systematic Review


  • Komang Mahendra Laksana Department of Orthopaedics and Traumatology, Wangaya General Hospital, Denpasar, Bali
  • IGN Wien Aryana Department of Orthopaedics and Traumatology, Consultant of Orthopaedic Sports Injury & Arthroscopy, Faculty of Medicine Udayana University and Sanglah General Hospital, Denpasar, Bali



Anterior Cruciate Ligament Rupture, Reconstruction, Lemaire, MacIntosh, outcomes


The purpose of this study was to systematically review the functional outcomes between lateral extraarticular tenodesis (LET) Modified Lemaire procedure and MacIntosh modified by Cocker-Arnold procedure other than ACL reconstruction (ACLR) alone in studies with high levels of evidence.

We performed a literature search for clinical studies comparing the LET Modified Lemaire procedure and MacIntosh modified by Cocker-Arnold procedure as an augmentation to ACLR with ACLR alone. The primary outcomes were the
International Knee Documentation Committee (IKDC) score, the Lysholm score, and graft failures.

A systematic search on the literature was performed online from the inception dates to July 2022. Based on the screening of abstracts and titles, a total of 123 records were excluded. The authors independently based on the extracted full text.
This selection process resulted in the final 6 articles for inclusion in the systematic review. The remaining 6 studies were eventually included, consisting of 2 randomized controlled trials, 2 retrospective studies and 2 prospective studies.
ACLR with the LET provides better functional outcomes than ACLR alone, whereas between the two LET i.e. Lemaire and MacIntosh in the ACLR action do not give different functional outcomes.

ACLR with the LET provides better functional results than ACLR without the LET, the LET provides better rotational stability than ACLR alone, and also lower graft failures than ACLR alone. Meanwhile, between the two LET, namely the
Lemaire and MacIntosh in ACLR, do not give different functional results because they can maintain rotational stability to reduce the incidence of graft failure and later will provide better functional outcomes.


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