Course Lecture Pearls: Advanced Knee-Articular Cartilage-Lateral Extra-articular Procedures_ When or Ever Should They be Used with an ACLR (with Technique Options)-Faculty Lecture

Lateral Extra-articular Procedures_ When or Ever Should They be Used with an ACLR (with Technique Options)-Faculty Lecture_ Andrew G. Geeslin, MD

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Video Transcription

Video Summary

This talk discusses the anterolateral ligament (ALL) and lateral extra-articular procedures in ACL revision surgery. Interest surged after a 2013 paper reignited study of the ALL, an anatomical structure involved in knee rotational stability. Anatomy and biomechanics reveal the ALL and related structures serve as secondary stabilizers to tibial internal rotation. Two surgical approaches exist: ALL reconstruction with free grafts, or lateral extra-articular tenodesis (LAT) using a strip of the iliotibial band. Evidence, including recent randomized trials, shows combined ACL and LAT reduces graft rupture and pivot shift in high-risk patients. However, clinical indications remain limited and selective.

Keywords

anterolateral ligament

ACL revision surgery

lateral extra-articular tenodesis

knee rotational stability

graft rupture prevention