AOSSM/AANA Specialty Day 2020-Handout 1 - ACL Augmentation_ ALL or ITB Tenodesis

Handout 1 - ACL Augmentation_ ALL or ITB Tenodesis – When and How_

Pdf Summary

This presentation by Dr. Alan Getgood discusses the augmentation of anterior cruciate ligament (ACL) reconstruction using anterolateral ligament (ALL) reconstruction or iliotibial band (ITB) tenodesis, focusing on indications, techniques, and clinical efficacy.<br /><br />Anatomy and biomechanics show that the anterolateral complex (ALC)—comprising the superficial IT band, deep IT band including Kaplan fibers, and the ALL—plays a key role in controlling internal tibial rotation and anterolateral rotatory laxity. The 2017 ALC consensus outlined these structures’ components and their biomechanical contributions.<br /><br />Clinical evidence, including the large Stability Study involving 618 patients under age 25 across nine centers, demonstrates that adding a lateral extra-articular tenodesis (LET), specifically a modified Lemaire procedure, to ACL reconstruction significantly reduces graft failure rates (25% with LET vs. 40% without) and graft ruptures (4% vs. 11%). LET is a simple, low-cost procedure with a long clinical history and strong preclinical support.<br /><br />Indications for LET include revision ACL surgery where other issues are absent, and primary reconstruction in high-risk patients demonstrating grade 2/3 pivot shift, such as young athletes, generalized ligamentous laxity, recurvatum, or participation in pivoting sports.<br /><br />While both ALL reconstruction and LET reduce ACL graft failure, the presentation favors LET with modified Lemaire technique for its established efficacy, safety, and minimal adverse events.<br /><br />In summary, abundant biomechanical and clinical data support the role of the anterolateral complex in enhancing rotational stability after ACL reconstruction. Adding LET reduces clinical failure and pivot shift, especially in high-risk populations. This approach is well-supported by systematic reviews and multi-center trials, confirming its utility in both primary and revision ACL reconstructions.<br /><br />Acknowledgments note extensive multidisciplinary collaboration across international centers in conducting the research.

Keywords

anterior cruciate ligament reconstruction

anterolateral ligament reconstruction

iliotibial band tenodesis

anterolateral complex biomechanics

lateral extra-articular tenodesis

modified Lemaire procedure

ACL graft failure reduction

pivot shift grading

high-risk ACL patients

multicenter clinical trials