AANA/SOMOS Course Materials (August 2021)-Anterolateral Ligament Reconstruction Demo

Video Transcription

Video Summary

The speaker discusses considerations for ACL reconstruction, specifically incorporating lateral extra-articular tenodesis (LET) to address residual pivot shifts present in about 15% of cases, even with standard techniques. LET involves harvesting a middle third portion of the iliotibial (IT) band while preserving the posterior segment linked to Kaplan fibers, which contribute to rotational stability. The graft is routed under the lateral collateral ligament (LCL) and fixed typically at about 60 degrees of knee flexion using an interference screw, with tensioning done neutrally to avoid over-rotation—a common issue in older techniques. The procedure is more forgiving in graft tensioning and placement compared to anterolateral ligament (ALL) reconstruction. LET use is becoming more popular, especially for hyperlax patients, as studies show improved rotational control with soft tissue grafts. The speaker anticipates further study results but shares personal experience with increasing adoption over the past several years.

Keywords

ACL reconstruction

lateral extra-articular tenodesis

pivot shift

iliotibial band graft

rotational stability

knee surgery techniques