AOSSM/AANA Specialty Day 2020-Handout 2 - ACL Augmentation_ ALL or ITB Tenodesis

Handout 2 - ACL Augmentation_ ALL or ITB Tenodesis – When and How_

Pdf Summary

This presentation by Dr. Alan Getgood addresses the role and technique of lateral extra-articular tenodesis (LET), particularly the modified Lemaire procedure, and anterolateral ligament (ALL) reconstruction as augmentations to anterior cruciate ligament reconstruction (ACLR) to improve knee stability and reduce graft failure. The anterolateral complex comprises layered structures including the superficial and deep iliotibial (IT) bands, Kaplan fibers, and the ALL, which collectively control internal tibial rotation and anterolateral rotatory laxity.<br /><br />Clinical evidence from a multicenter randomized trial involving 618 patients under 25 at high risk for graft failure (e.g., young age, ligamentous laxity, participation in pivoting sports) demonstrated that adding LET to hamstring tendon ACLR significantly reduces clinical failure rates (from 40% down to 25%) and graft rupture (11% down to 4%). These results reinforce the biomechanical rationale that the anterolateral complex supports ACL function.<br /><br />LET is a relatively simple, inexpensive procedure with a long clinical history and strong preclinical evidence supporting its use, especially in revisions or high-risk primary ACLRs with grade 2/3 pivot shifts. The presentation contrasts ALL reconstruction and LET, showing LET provides greater reduction in internal rotation torque, thus enhancing stability.<br /><br />In summary, abundant scientific data—biomechanical, clinical, and systematic reviews—support the addition of an anterolateral procedure (usually LET) to improve rotational stability and reduce graft failure risk after ACL reconstruction. The Stability Study and related research define clear indications for this augmentation in selected patients. The presentation also credits multiple collaborators and institutions supporting this research.<br /><br />Keywords: ACL reconstruction, lateral extra-articular tenodesis (LET), anterolateral ligament (ALL), knee stability, graft failure, internal rotation control, modified Lemaire technique, high-risk patients.

Keywords

ACL reconstruction

lateral extra-articular tenodesis

modified Lemaire procedure

anterolateral ligament reconstruction

knee stability

graft failure reduction

anterolateral complex

internal tibial rotation control

high-risk patients

pivot shift