Optimizing ACL Reconstruction in 2022: A Case-Based Approach (AANA22)-ACL Reconstruction Augmentation

Video Transcription

Video Summary

The discussion centers on advanced techniques and considerations in ACL (anterior cruciate ligament) reconstruction, particularly focusing on lateral augmentation procedures (like lateral extra-articular tenodesis [LET] and anterolateral ligament [ALL] reconstruction) and internal suture tape augmentation. The panel reviews a complex case of a young, active female with three prior failed ACL reconstructions, complicated by ligamentous laxity, hyperextension, and lateral corner injury. They emphasize the importance of addressing lateral knee structures to reduce rotational instability, citing biomechanical studies showing increased pivot shift with lateral side injury. Recent randomized trials show combining LET with ACL reconstruction significantly lowers re-rupture rates in high-risk patients, especially young athletes, without delaying return to sport.<br /><br />The panel contrasts LET and ALL procedures, noting limited comparative data but similar patient outcomes. They highlight internal suture tape augmentation ("seatbelt" technique) as promising biomechanically to support grafts during early healing, though clinical outcomes are still being studied. Indications for lateral augmentation or suture tape include revision cases, high laxity patients, and those in pivoting sports. Contraindications include multiligament injuries and lateral compartment arthritis.<br /><br />Graft choices favor quadriceps tendon autografts for reliability and size, especially in young females. Discussion touches on challenges of pediatric ACL reconstruction, partial vs. full-thickness graft harvest, and re-harvesting grafts in revisions. Overall, the panel advocates personalized, evidence-informed approaches balancing graft type, augmentation techniques, and patient risk factors to optimize ACL reconstruction success.

Asset Caption

Clayton W. Nuelle, M.D.

Keywords

ACL reconstruction

lateral augmentation

lateral extra-articular tenodesis

anterolateral ligament reconstruction

internal suture tape augmentation

ligamentous laxity

quadriceps tendon autograft

rotational instability