Editorial Commentary: Lateral Extra-Articular Tenodesis Reduces Anterior Cruciate Ligament Graft Rerupture Rates: Proper Anterior Cruciate Ligament and Lateral Extra-Articular Tenodesis Technique Is Vital to Prevent Complications

Williams, Andy

doi:10.1016/j.arthro.2021.11.029

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…The point of femoral fixation of the graft is then identified. This point should be proximal and posterior to the origin of the LCL from the lateral epicondyle 13 ( Fig 5 ). This point is marked with an electrocautery tip.…”

Section: Surgical Techniquementioning

confidence: 99%

ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation

Koukoulias¹,

Dimitriadis²,

Vasiliadis³

et al. 2022

Arthroscopy Techniques

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Section: Surgical Techniquementioning

confidence: 99%

ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation

Koukoulias¹,

Dimitriadis²,

Vasiliadis³

et al. 2022

Arthroscopy Techniques

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“…20,36,40,48 Lateral extra-articular tenodesis (LET) in conjunction with ACLR can reduce rates of ACL graft failure and, therefore, has seen increased clinical use. 18,37,45,56 Notably, a multicenter, prospective, randomized controlled trial revealed that augmenting a single-bundle hamstring tendon autograft ACLR with LET in high-risk populations reduced rates of ACL graft retear and persistent rotatory knee laxity. 18 Despite increased use of LET in conjunction with ACLR, important gaps in knowledge remain regarding the The American Journal of Sports Medicine 2024;52(1):87-95 DOI: 10.1177/03635465231211534 Ó 2024 The Author(s)…”

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confidence: 99%

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confidence: 99%

Role of Lateral Extra-articular Tenodesis in Restraining Internal Tibial Rotation: In Vitro Biomechanical Assessment of Lateral Tissue Engagement

Ahsan,

Berube,

Frondorf

et al. 2024

Am J Sports Med

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Background: The way in which force increases in the anterolateral tissues and the lateral extra-articular tenodesis (LET) tissue to resist internal rotation (IR) of the tibia after anterior cruciate ligament (ACL) reconstruction in isolation and after LET augmentation, respectively, is not well understood. Purpose: (1) To compare in a cadaveric model how force increases (ie, engages) in the anterolateral tissues with IR of the tibia after isolated ACL reconstruction and in the LET tissue after augmentation of the ACL reconstruction with LET and (2) to determine whether IR of the tibia is related to engagement of the LET tissue. Study Design: Controlled laboratory study. Methods: IR moments were applied to 9 human cadaveric knees at 0°, 30°, 60°, and 90° of flexion using a robotic manipulator. Each knee was tested in 2 states: (1) after isolated ACL reconstruction with intact anterolateral tissues and (2) after LET was performed using a modified Lemaire technique with the LET tissue fixed at 60° of flexion under 44 N of tension. Resultant forces carried by the anterolateral tissues and the LET tissue were determined via superposition. The way force increased in these tissues was characterized via parameters of tissue engagement, namely in situ slack, in situ stiffness, and tissue force at peak applied IR moment, and then compared (α < .05). IR was related to parameters of engagement of the LET tissue via simple linear regression (α < .05). Results: The LET tissue exhibited less in situ slack than the anterolateral tissues at 30°, 60°, and 90° of flexion ( P≤ .04) and greater in situ stiffness at 30° and 90° of flexion ( P≤ .043). The LET tissue carried greater force at the peak applied IR moment at 0° and 30° of flexion ( P≤ .01). IR was related to the in situ slack of the LET tissue ( R2≥ 0.88; P≤ .0003). Conclusion: LET increased restraint to IR of the tibia compared with the anterolateral tissue, particularly at 30°, 60°, and 90° of flexion. IR of the tibia was positively associated with in situ slack of the LET tissue. Clinical Relevance: Fixing the LET at 60° of flexion still provided IR restraint in the more functionally relevant flexion angle of 30°. Surgeons should pay close attention to the angle of internal and/or external tibial rotation when fixing the LET tissue intraoperatively because this surgical parameter is related to in situ slack of the LET tissue and, therefore, the amount of IR of the tibia.

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“…[11][12][13] In comparison, anchor fixation of the LET (aLET) has been described in the literature, but comparative studies of the 2 techniques are missing. 23,30,38 In addition, passing the LET graft under the LCL has demonstrated more isometric behavior as compared with passing it over the LCL. 12,13 With respect to the graft passage relative to the LCL, both techniques have been described in clinical application, but data are limited about its significance for ACLR failure and clinical outcome.…”

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confidence: 99%

Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction

Behrendt

Fahlbusch

Akoto

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: There is evidence on the clinical effectiveness of the Lemaire technique for lateral extra-articular tenodesis (LET) in patients undergoing revision anterior cruciate ligament reconstruction (ACLR), but the best fixation technique is unknown. Purpose: To compare the clinical outcomes of 2 fixation techniques after revision ACLR: (1) onlay anchor fixation, which would avoid tunnel conflict and physis injury, and (2) transosseous tightening and interference screw fixation. Pain at the area of LET fixation was also assessed. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective 2-center study of patients with first-time revision ACLR and either LET with anchor fixation (aLET) with a 2.4-mm suture anchor or LET with transosseous fixation (tLET). Outcomes at minimum 12-month follow-up were assessed with the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain at the LET fixation area, Tegner score, and anterior tibial translation (ATT). A subgroup analysis within the aLET group investigated passing the graft over or under the lateral collateral ligament (LCL). Results: In total, 52 patients were included (26 patients in each group); the mean ± SD follow-up was 13.7 ± 3.4 months. No statistically significant differences were detected between the groups with respect to patient-reported outcome scores, clinical examination, or instrumented testing (side-to-side difference in ATT at 30° of flexion; aLET, 1.5 ± 2.5 mm; tLET, 1.6 ± 1.7 mm). Clinical failure was detected in 1 patient with aLET and none with tLET. Subgroup analysis revealed a small, nonsignificant flexion deficit in knees in which the iliotibial band strand was passed under (n = 42) or over (n = 10) the LCL. No clinically relevant tenderness was detected at the area of LET fixation in any group (aLET, 0.6 ± 1.3; tLET, 0.9 ± 1.7; over the LCL, 0.2 ± 0.6; under the LCL, 0.9 ± 1.6). Conclusion: Onlay anchor fixation and transosseous fixation of the LET were equivalent with respect to outcome scores and instrumented ATT testing. Clinically, there were minor differences in passage of the LET graft over or under the LCL.

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Editorial Commentary: Lateral Extra-Articular Tenodesis Reduces Anterior Cruciate Ligament Graft Rerupture Rates: Proper Anterior Cruciate Ligament and Lateral Extra-Articular Tenodesis Technique Is Vital to Prevent Complications

Cited by 5 publications

References 9 publications

ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation

ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation

Role of Lateral Extra-articular Tenodesis in Restraining Internal Tibial Rotation: In Vitro Biomechanical Assessment of Lateral Tissue Engagement

Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction

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