Iliotibial Band Tenodesis With a Tenodesis Screw for Augmentation of Anterior Cruciate Ligament Reconstruction

Abstract

Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis using a strip of the iliotibial band (ITB) has been shown to increase postoperative stability of the knee. This Technical Note describes a method of ITB tenodesis in which a central slip of the ITB is passed deep to the lateral collateral ligament and then rerouted anteriorly for fixation at a location anterior and proximal to the lateral femoral epicondyle. Five whipstitches are passed through the ITB, and a second distal suture is tied around the distal end. Of the 4 suture tails, 3 are passed through a tenodesis screwdriver, and the screw is placed in the previously reamed bone socket. A closed loop is formed around the tenodesis screw by tying off the suture tails. This technique creates a sling around the lateral collateral ligament, which serves as a checkrein to internal rotation in cases in which increased stability is warranted, such as revision anterior cruciate ligament reconstruction in an athlete.

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

“…A similar technique was reported before using a tenodesis screw. 27 As illustrated in Figure 2, the close proximity of the femoral ACL tunnel exit and ideal LET fixation point favors a small anchor without the need of predrilling, which was recently confirmed in a biomechanical study. 41 Nevertheless, we recommend placing the anchor before pulling in the ACL graft to minimize any interference with the femoral ACL fixation implant.…”

Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device

“…Numerous variations of the isolated LET are described in the literature. In particular, the main differences concern proximal fixation, which can be performed using suture anchors [52], interference screws [53], extracortical suspensory systems [54], staples [55] or by suturing the ITB graft onto itself [56]. Each of these fixation methods has proven effective, with no differences reported in the literature regarding failure rates and patientreported outcomes; however, different potential risks and complications are described.…”

ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation

“…For the femoral fixation of the ITB graft, a variety of methods have been used like screw, 20 staple, 21 suture anchor, 22 or even no implants at all. 23 Our method of fixation (adjustable button) mimics the function of the staple, as it compresses the ITB graft against the femur, while suturing of the graft to itself also mimics the technique without implants.…”