Lateral Extra-Articular Tenodesis via an All-Suture Anchor

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Anterior cruciate ligament (ACL) reconstruction in young patients frequently fails, potentially due to associated anterolateral complex (ALC) injuries causing rotatory instability.
• The anterolateral complex (ALC) plays a crucial role in knee stability, and its injury can compromise ACL graft integrity.
• The modified Lemaire lateral extra-articular tenodesis (LET) aims to stabilize the ALC, reduce rotatory laxity, and protect the ACL graft and meniscus.

Purpose of the Study:

• To evaluate the efficacy and safety of the modified Lemaire lateral extra-articular tenodesis (LET) as an adjunct to anterior cruciate ligament (ACL) reconstruction.
• To determine if the LET procedure can address anterolateral rotatory instability and reduce ACL graft failure in specific patient populations.
• To assess the impact of LET on restoring native knee kinematics and preventing residual laxity.

Main Methods:

• The modified Lemaire LET technique involves harvesting an iliotibial band graft and securing it to the lateral femoral epicondyle.
• The graft is passed deep to the lateral collateral ligament (LCL) and tensioned with the knee at 30° flexion and neutral rotation.
• Indications for the procedure include revision ACL reconstruction, high-grade pivot shift, generalized ligamentous laxity, and young athletes in pivoting sports.

Main Results:

• Recent studies indicate no increased risk of overconstraint or lateral compartment degeneration with the modified Lemaire LET.
• The STABILITY trial demonstrated that adding LET to ACL reconstruction significantly decreases re-rupture rates and residual laxity compared to ACL reconstruction alone.
• The combined procedure has been shown to restore native knee kinematics.

Conclusions:

• The modified Lemaire LET is a safe and effective addition to traditional ACL reconstruction.
• This technique successfully reduces ACL graft rupture and addresses rotational laxity.
• LET can restore native knee kinematics in appropriately selected patients, improving overall outcomes.