AOSSM/AANA Specialty Day 2020-ACL Augmentation_ ALL or ITB Tenodesis

ACL Augmentation_ ALL or ITB Tenodesis – When and How_

Video Transcription

Video Summary

Al Gatgood, an orthopedic surgeon, discusses ACL augmentation and the use of anterolateral ligament (ALL) or iliotibial band (ITB) tenodesis. He reviews the anatomy and biomechanics of the anterolateral complex, noting the role of different structures in controlling internal knee rotation. Biomechanical studies show the ACL primarily manages rotation near extension, while the deep IT band plays a key role at higher flexion angles. Clinical evidence, including the multicenter Stability Study, demonstrates that adding a lateral tenodesis to ACL reconstruction significantly reduces graft failure and rotational laxity, especially in high-risk patients like young athletes returning to pivoting sports. Gatgood favors the modified Lemaire lateral extra-articular tenodesis technique due to its simplicity and effectiveness. Alternative techniques, such as ALL reconstruction, also show promising results but require more graft and fixation. Overall, combined procedures improve stability and reduce re-injury risk in high-risk ACL reconstructions.

Keywords

ACL augmentation

anterolateral ligament (ALL)

iliotibial band (ITB) tenodesis

lateral extra-articular tenodesis

ACL reconstruction stability