Macintosh tenodesis for anterolateral instability of the knee

Abstract

Requests for reprints should be sent to Mr J. Ireland. We are indebted to the Photographic Department of the Institute of Orthopaedics and to Miss Kathleen Ockendon for the illustrations and to Mrs Elisabeth Scott for her invaluable administrative and secretarial work.

The Fascia Lata Anterolateral Tenodesis Technique

“…3 The role of secondary restraints of the lateral aspect of the knee has been clearly shown in the past, so several lateral extra-articular procedures have been proposed. [12][13][14] However, their indications are still controversial in the literature. 3,[15][16][17] Recently, the ALL has been described as a distinct structure extending proximally and posteriorly to the lateral epicondyle to a point midway between the Gerdy tubercle and fibular head.…”

“…Indications for the proposed technique are higher grades of the pivot-shift test, high-risk athletes, and revision surgery. A strip of ITT has been widely used in the past for extra-articular nonanatomic tenodesis, [12][13][14] with good results at long-term follow-up. 15,[23][24][25] Moreover, the biomechanical effect of such procedures in controlling rotational stability of the knee has also been shown with the aid of navigation.…”

“…Second, because the ITT is another important secondary restraint of the knee, the use of a strip of ITT could weaken such a structure. 26,27 Nevertheless, strips of ITT have been widely used for extra-articular tenodesis in the past, [12][13][14] with no relation in long-term follow-up results 15,[23][24][25] in terms e84 of osteoarthritis. Moreover, the reconstruction is performed under the ITT, which can be sutured at the end of the procedure.…”

Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee

“…Multiple authors have proposed various techniques for this purpose. In ALES reconstruction, a strip of the ITT is typically routed beneath the LCL and looped back to the Gerdy tubercle through a bone tunnel in the lateral femoral condyle, 14,15 through a suture fixation on the intermuscular septum, 16 or through the over-the-top position after an intraarticular ACL reconstruction. 17 However, results of additional ALES reconstruction with ACL reconstruction are mixed.…”

Prospective Stress Radiography in 38 Old Injuries of the Ligaments of the Knee Joint

“…On the other hand, old, neglected ligament injuries pose many therapeutic problems (Chick et al 1981, Ellison 1979, Fetto & Marshall 1980, Ireland & Trickey 1980, Jones 1970, Kennedy et al 1974, Nicholas 1973. The reconstructive procedures are often comprehensive and technically difficult and, most important of all, the operative indications are often poorly defined.…”