ACL and extra-articular tenodesis

Abstract

Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopedic surgical procedures performed. There have been concerns with the inability of an ACLR to reliably restore normal tibial rotation. Various iterations of the lateral extra-articular tenodesis (LET) have been used in an attempt to address anterolateral laxity in an ACL-deficient knee. Initial results with isolated LET were poor in terms of patient satisfaction and subjective clinical testing using a pivot shift test. There is a renewed interest in using LET as an adjunct procedure to a conventional ACLR, as the body of literature looking at a combination procedure has provided more promising results. Our current clinical indications for using LET to augment an ACLR include significant anterolateral laxity (pivot shift grade 2 or greater), young patient age (<20 years), genu recurvatum >10°, or participation in a high-risk pivoting sport.