Abstract
Anterior cruciate ligament (ACL) tears are among the most common injuries of the knee. Although most authors describe good results of ACL reconstruction with modern techniques, restoring the anterolateral rotational stability completely and controlling the pivot-shift phenomenon remains a concern. Of specific concern is the role of the capsular and ligamentous structures on the lateral side of the knee. Recent literature has shown that lateral extra-articular tenodesis (LET) using an ITB strip tunnelled deep to the lateral collateral ligament is an excellent method to address rotational control in combination with all inside ACL reconstruction. In the following chapter we describe our technique for a combined intra-articular ACL reconstruction together with a lateral extra-articular tenodesis we refer to as the “monoloop” LET (mLET) technique. Indications for using the mLET technique are patients who participate in activities with high level of pivoting or cutting maneuvers, patients who present with hyperlaxity or with a high grade of pivot shift, patients who have a high tibial slope, patients of 25 years of age or younger, and in all cases of revision ACL.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Ferretti A, Monaco E, Fabbri M, Mazza D, De Carli A. The fascia lata anterolateral tenodesis technique. Arthrosc Tech. 2017;6(1):e81–6.
Tanaka M, Vyas D, Moloney G, Bedi A, Pearle AD, Musahl V. What does it take to have a high-grade pivot shift? Knee Surg Sport Traumatol Arthrosc. 2012;20(4):737–42.
Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223(4):321–8.
Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM. Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthrosc J Arthrosc Relat Surg. 2015;31(10):2022–34.
Getgood A, Brown C, Lording T, et al. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surgery, Sport Traumatol Arthrosc. 2019;27(1):166–76.
Musahl V, Getgood A, Neyret P, et al. Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion. Knee Surg Sport Traumatol Arthrosc. 2017;25(4):997–1008.
Herbst E, Albers M, Burnham JM, et al. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sport Traumatol Arthrosc. 2017;25(4):1009–14.
Kittl C, El-Daou H, Athwal KK, et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med. 2016;44(2):345–54.
Geeslin AG, Chahla J, Moatshe G, et al. Anterolateral knee extra-articular stabilizers: a robotic sectioning study of the anterolateral ligament and distal iliotibial band Kaplan fibers. Am J Sports Med. 2018;46(6):1352–61.
Lagae KC, Robberecht J, Athwal KK, Verdonk PCM, Amis AA. ACL reconstruction combined with lateral monoloop tenodesis can restore intact knee laxity. Knee Surg Sport Traumatol Arthrosc. 2020;28(4):1159–68.
Devitt BM, Bell SW, Ardern CL, et al. The role of lateral extra-articular tenodesis in primary anterior cruciate ligament reconstruction: a systematic review with meta-analysis and best-evidence synthesis. Orthop J Sport Med. 2017;5(10):1–12.
Song GY, Hong L, Zhang H, Zhang J, Li Y, Feng H. Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthrosc J Arthrosc Relat Surg. 2016;32(5):898–905.
Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial. Am J Sports Med. 2020;48(2):285–97.
Dodds AL, Gupte CM, Neyret P, Williams AM, Amis AA. Extra-articular techniques in anterior cruciate ligament reconstruction: a literature review. J Bone Jt Surg Ser B. 2011;93(11):1440–8.
O’Brien SJ, Warren RF, Wickiewicz TL, et al. The iliotibial band lateral sling procedure and its effect on the results of anterior cruciate ligament reconstruction. Am J Sports Med. 1991;19(1):21–5.
Claes T, Declerq G, Martens M, Lefevre J. Extra-articular ligamentoplasty for chronic ACL insufficiency. Acta Orthop Belg. 1986;52(4):515–25.
Magnussen RA, Lustig S, Jacobi M, Elguindy A, Neyret P. The role of lateral extra-articular augmentation in revision ACL reconstruction. In: Marx RG, editor. Revision ACL reconstruction. New York: Springer; 2013. p. 151–6.
Kaplan EB. The iliotibial tract: clinical and morphological significance. J Bone Jt Surg Ser B. 1958;40(4):817–32.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Appendix
Appendix
All figures are original.
Rights and permissions
Copyright information
© 2022 ISAKOS
About this chapter
Cite this chapter
Vanermen, F., Lagae, K.C., Declercq, G., Verdonk, P. (2022). Technical Corner: Lateral Extra-Articular Tenodesis. In: Nakamura, N., Marx, R.G., Musahl, V., Getgood, A., Sherman, S.L., Verdonk, P. (eds) Advances in Knee Ligament and Knee Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-84748-7_34
Download citation
DOI: https://doi.org/10.1007/978-3-030-84748-7_34
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-84747-0
Online ISBN: 978-3-030-84748-7
eBook Packages: MedicineMedicine (R0)