The Role of Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction and Treatment of Rotatory Knee Instability: a Scoping Review

Nazzal, Ehab M.; Keeling, Laura E.; Ryan, Patrick M.; Herman, Zachary; Hughes, Jonathan D.

doi:10.1007/s12178-023-09832-4

Cited by 13 publications

(4 citation statements)

References 78 publications

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“…In this exploratory study, the main findings were that (1) the HTT with LET diminishes ACLr graft stress more than HTT, TT, and AM without LET, and TT and AM with LET under medial rotation moment, and (2) for the AM portal, HTT, and TT techniques without LET show higher stress concentration patterns in the femoral tunnel. Thus, the HTT with LET FE model is suggested to be a surgical alternative to constrain isolated medial rotation moments during ACLr in agreement with Lemaire's principles for adding an LET technique [20,32]. The LET technique based on soft tissue modeled here reduced the ACLr stress in three surgical choices (TT, HTT, and AM techniques) and shifted the stress concentration from the femoral tunnel for HTT with LET.…”

Section: Discussionmentioning

confidence: 63%

“…This stress reduction is relevant to prevent graft failure and stress concentration in single-bundle ACLr [6]. LET biomechanics is generally similar to anterolateral ligament biomechanics because they have similar orientations, and both constrain medial knee rotation [19,20]. Lemaire, Macintosh, Losee, Arnold-Coker, Ellison, and others are different LET choices [6,17,18].…”

Section: Introductionmentioning

confidence: 99%

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Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band–Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels

Yañez,

Silvestre,

Roby

et al. 2024

Applied Sciences

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Traditional lateral extra-articular tenodesis (LET) using fixation elements constrains medial knee rotation laxity after anterior cruciate ligament reconstruction (ACLr). However, the mechanical behavior of an LET made with an iliotibial band–intermuscular septum is unknown using different anterior cruciate ligament (ACL) reconstruction drillings and would be crucial for constraining the rotatory components of direction change movements. Thus, this study aimed to explore the maximum principal stresses and their distribution in grafts during medial knee rotation with and without iliotibial band–intermuscular septum lateral extra-articular tenodesis for the transtibial technique (TT), hybrid transtibial technique (HTT), and anteromedial portal technique (AM) in single-bundle ACLr. The maximum von Mises principal stresses and their distribution under medial knee rotation were described using a finite element model generated from a healthy knee. LET with HTT, TT, and AM decreases stress by 97%, 93%, and 86% during medial rotation compared to each technique without LET, respectively. The stress concentration for the AM portal and TT techniques was located at the femoral tunnel, and for HTT with LET, it was located across the distal thirds of the anterior aspect of the graft. In conclusion, the HTT with LET diminishes graft stress more than the HTT, TT, and AM without LET, and the TT and AM with LET during medial knee rotation. The AM portal, HTT, and TT techniques without LET show higher stress concentration patterns at the femoral tunnel, establishing a biomechanical risk of femoral tunnel enlargement when LET is not performed.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band–Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels

Yañez,

Silvestre,

Roby

et al. 2024

Applied Sciences

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“…In fact, in 2017, the Anterolateral Ligament Expert Group considered age <25 years a secondary criterion for an increased risk of secondary ACL rupture or postoperative residual pivot shift, and they postulated that a combined ACLR + ALLR must be considered for such patients. 40 A recent review by Nazzal et al 27 underlined the fact that LEAP should be performed in patients aged <25 years. In an editorial commentary published in 2023, Servant 36 emphasized that LEAP may be reserved for high-risk patients, especially those who are young (14-25 years old) and active in pivoting sports.…”

Section: Discussionmentioning

confidence: 99%

Effect of Lateral Extra-Articular Procedures Combined With ACL Reconstruction on the Rate of Graft Rupture in Patients Aged Older Than 30 Years: A Matched-Pair Analysis of 1102 Patients From the SANTI Study Group

Pettinari,

Carrozzo,

Saithna

et al. 2024

Am J Sports Med

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Background: Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) reconstruction (ACLR) and lateral extra-articular procedures (LEAPs) over isolated ACLR in terms of reducing graft rupture and reoperation rates. However, most of the published studies have included young patients, and no studies have focused on patients aged >30 years. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at midterm follow-up in patients aged >30 years. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients >30 years of age who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched at a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was performed to determine graft rupture rates, knee stability, reoperation rates, and complications. Graft survivorship was assessed using the Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model. Results: Two groups of 551 patients each were included in the study, and the mean follow-up was 97.19 ± 47.23 months. The overall mean age was 37.01 ± 6.24 years. The LEAP group consisted of 503 (91.3%) patients who had anterolateral ligament reconstruction and 48 (8.7%) patients who had a Lemaire procedure. Overall, 19 (1.7%) patients had graft failure: 15 (2.7%) in the no-LEAP group and 4 (0.7%) in the LEAP group ( P = .0116). The risk of graft failure was significantly associated with the absence of LEAP (31 vs 12; hazard ratio, 3.309; 95% CI, 1.088-10.065; P = .0350) and age between 30 and 35 years (hazard ratio, 4.533; 95% CI, 1.484-13.841; P = .0080). A higher rate of reoperation for secondary meniscectomy was found in the no-LEAP group (5.6% vs 2.2%; P = .0031). Conclusion: Patients aged >30 years who underwent combined ACLR and LEAP experienced a >3-fold lower risk of ACL graft failure compared with those who underwent isolated ACLR. Furthermore, the group without LEAP experienced a higher rate of secondary meniscectomy.

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“…In a current review Garcia-Mansilla et al noted the importance of the anterolateral complex [ 27 ]. And especially in the case of recurrent anterior cruciate ligament ruptures, excessive rotational laxity is evident [ 21 , 37 ]. The anterolateral soft tissue complex including the capsule, the Kaplan fibers and the IT band as a secondary stabilizer to the anterior cruciate ligament is increasingly understood [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Digital measurement of anterolateral knee laxity using strain sensors

Mayr,

Rosenstiel,

Prakash

et al. 2023

Arch Orthop Trauma Surg

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Purpose The ambition of the research group was to develop a sensor-based system that allowed the transfer of results with strain sensors applied to the knee joint. This system was to be validated in comparison to the current static mechanical measurement system. For this purpose, the internal rotation laxity of the knee joint was measured, as it is relevant for anterolateral knee laxity and anterior cruciate ligament (ACL) injury. Methods This is a noninvasive measurement method using strain sensors which are applied to the skin in the course of the anterolateral ligament. The subjects were placed in supine position. First the left and then the right leg were clinically examined sequentially and documented by means of an examination form. 11 subjects aged 21 to 45 years, 5 women and 6 men were examined. Internal rotation of the lower leg was performed with a torque of 2 Nm at a knee flexion angle of 30°. Results Comparison of correlation between length change and internal knee rotation angle showed a strong positive correlation (r = 1, p < 0.01). Whereas females showed a significant higher laxity vs. males (p = 0.003). Conclusions The present study showed that the capacitive strain sensors can be used for reproducible measurement of anterolateral knee laxity. In contrast to the previous static systems, a dynamic measurement will be possible by this method in the future.

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The Role of Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction and Treatment of Rotatory Knee Instability: a Scoping Review

Cited by 13 publications

References 78 publications

Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band–Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels

Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band–Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels

Effect of Lateral Extra-Articular Procedures Combined With ACL Reconstruction on the Rate of Graft Rupture in Patients Aged Older Than 30 Years: A Matched-Pair Analysis of 1102 Patients From the SANTI Study Group

Digital measurement of anterolateral knee laxity using strain sensors

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