Vincent Chassaing MD

 

The Lemaire operation is so-called "extra-articular." The ligament is not placed within the joint itself, but along the outside portion of the knee joint. It is not an anatomic reconstruction and does not control the "anterior drawer." However, it can control some of the rotational instability associated with the tear of the ACL.

Historical Review

The operation was devised by Dr. Marcel Lemaire and was described in the "Journal De Chirurgie' in 1967 (3). He had used it for the first time in 1960 on a dancer who had been forced to quit her job because of knee instability. This operation allowed her to resume her career.

At the time, most operations involved major surgical dissections followed lengthy periods of immobilization. The Lemaire operation had the advantage of involving only a small surgical dissection and it did not require any immobilization. It controlled a significant portion of patients' symptoms and a number of athletes were able to continue competitive athletics. At the present, the indications for "the Lemaire" are quite limited.

 

Surgical Technique

 The purpose of the operation is to span the outside portion of the knee joint with a soft tissue band, which will control the rotation of the tibia on the femur. This band of tissue is obtained from the "fascia lata" which is a wide, thin membrane running along the outer aspect of the thigh.

 

A 1 cm wide band of fascia lata is harvested while maintaining its insertion on the tibia

A semi-circular tunnel is created with a special curved rasp

The fascia lata band is slipped under the fibular collateral ligament and then threaded through the tunnel	The fascia lata band is tightened and stitched back unto itself	Final Appearance of the Graft

Post operative care

No immobilization is required. The patient puts as much as weight as he or she is capable of. Crutches or two canes are recommended for three weeks after which physical therapy is initiated and continued for one and half months.

 

Current indications of the Lemaire

The great strides that have been made in intra-articular reconstructions have been made at the expense of the Lemaire operation. In fact at this point the isolated Lemaire operation is rarely indicated. It still has a place, however, as an adjunct to intra-articular procedures. The athlete's primary sport and the degree of knee instability guide the surgeon in his choice. The Lemaire can also be considered in certain partial tears of the ACL.

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