Technical Variations in Lateral Extra-Articular Tenodesis for Anterior Cruciate Ligament Reconstruction: A Systematic...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Anterior cruciate ligament (ACL) reconstruction often requires supplemental procedures for anterolateral stability.
• Lateral Extra-articular Tenodesis (LET) is a technique gaining attention for its role in enhancing ACL reconstruction outcomes.
• A comprehensive review of current LET methodologies is needed to guide clinical practice.

Purpose of the Study:

• To systematically review and synthesize data on various Lateral Extra-articular Tenodesis (LET) techniques used in ACL reconstruction.
• To identify common surgical approaches, graft materials, fixation methods, and fixation locations in LET procedures.
• To evaluate the current evidence regarding the reliability and reproducibility of different LET techniques.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Cochrane Central, ScienceDirect, Web of Science, Embase) in November 2023.
• Studies reporting on indications, surgical technique, graft type, fixation method, and tibial fixation location for LET in ACL reconstruction were included.
• Data extraction and quality assessment were performed following PRISMA guidelines and the Cochrane Risk of Bias Tool.

Main Results:

• Thirty-five papers were reviewed, detailing seven distinct LET surgical techniques.
• The Lemaire-modified procedure was the most frequently used technique (17 papers), followed by the MacIntosh technique (10 papers).
• The iliotibial band was the most common graft material, with sutures as the prevalent fixation method, typically at Gerdy's tubercle for tibial fixation.

Conclusions:

• The Lemaire-modified LET procedure demonstrates a consensus for reliability and reproducibility in clinical practice for ACL reconstruction.
• The consistent use of the iliotibial band and suture fixation highlights their accessibility and biomechanical suitability.
• Variability in femoral fixation points suggests ongoing debate and the need for further comparative studies to optimize surgical strategies.