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Lateral extra articular tenodesis

David A Pula
The anterior lateral complex is commonly associated with anterior cruciate ligament (ACL) injury. This has been evident since the description of the Segond fracture and by the use of lateral extra-articular tenodesis for ACL injury. Although lateral extra-articular tenodesis has been mostly given up owing to a preference for anatomic ACL reconstructions, it is gaining interest as an adjunct to ACL reconstruction. To determine the need for an anterolateral procedure we need to be able to identify those patients with deficiency in the anterolateral complex...
February 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Ryan Wood, Jacquelyn Marsh, Alan Getgood
Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not always reflected in clinical outcome trials...
December 2018: Techniques in Orthopaedics: TIO
Lachlan Batty, Timothy Lording
In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some patients, however, have ongoing instability or suffer graft rupture. Failure after ACL reconstruction is multifactorial, but residual anterolateral rotatory laxity is 1 potential contributing factor. Lateral extra-articular procedures are a heterogenous group of operations that were initially described as isolated treatments for the ACL deficient knee, and subsequently used in combination with intra-articular reconstructions...
December 2018: Techniques in Orthopaedics: TIO
Mitchell I Kennedy, Christopher M LaPrade, Andrew G Geeslin, Robert F LaPrade
Residual anterolateral rotatory laxity following injury and reconstruction of the anterior cruciate ligament (ACL) has become a popular topic and has generated interest in characterizing the relative contribution from the anterolateral structures of the knee. Studies have reported on the anatomic and biomechanical features of the anterolateral ligament (ALL), revealing a role in restraining internal tibial rotation in both ACL-intact and ACL-deficient knees. The Kaplan fibers of the iliotibial band have also been reported to provide significant restraint to internal tibial rotation...
December 2018: Techniques in Orthopaedics: TIO
Joseph S Tramer, Mohsin S Fidai, Omar Kadri, Toufic R Jildeh, Zamaan Hooda, Eric C Makhni, Terrence Lock
Background: A proposed mechanism for recurrent instability following anterior cruciate ligament (ACL) reconstruction is failure of the anterolateral ligament (ALL). Presently, there are a number of approaches to treating ALL pathology. Purpose: To determine practice patterns among orthopaedic surgeons regarding ALL during ACL reconstruction. Study Design: Cross-sectional study. Methods: An online 7-question survey was sent to all physicians registered with the American Orthopaedic Society for Sports Medicine between June and July 2017...
December 2018: Orthopaedic Journal of Sports Medicine
Darren L Johnson, Jacob B Stirton
As the overall incidence of anterior cruciate ligament (ACL) ruptures continues to rise, the failure rates in reconstructive surgery remain relatively stable. Despite advances in our understanding of graft selection, anatomic reconstruction, addressing concomitant injuries, and the importance of rehabilitation, we continue to see failure rates in primary ACL reconstructions of up to 15%. Thus as the number of primary ACL reconstructions rises, so too does the number of revision ACL surgeries. This rising need for revision ACL reconstructions presents an even more daunting task because failure rates of up to 25% have been reported...
December 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
M Wurm, E Herbst, P Forkel, A B Imhoff, M Herbort
OBJECTIVE: Treatment of persistent anterolateral knee instability. INDICATIONS: Subjective/objective (rotational) instability of the knee after anatomic anterior cruciate ligament (ACL) reconstruction. ACL re-rupture including special demands (e.g., high-performance athletes, hyperlaxity) RELATIVE CONTRAINDICATIONS: Osteoarthritis, additional instability of the knee, which should be treated independently; non-anatomic ACL reconstruction with persisting instability should be treated first with anatomic ACL reconstruction...
November 26, 2018: Operative Orthopädie und Traumatologie
Andrea Redler, Raffaele Iorio, Edoardo Monaco, Francesco Puglia, Megan R Wolf, Daniele Mazza, Andrea Ferretti
PURPOSE: To present the mid- to long-term clinical and radiographic outcomes of a series of patients who underwent revision anterior cruciate ligament (ACL) reconstruction with doubled gracilis and semitendinosus (DGST) autograft and a lateral extra-articular tenodesis (LET). METHODS: Patients who underwent revision ACL reconstruction with DGST and LET by a single surgeon between January 1997 and December 2013 were included. Revision was indicated by ACL failure noted on magnetic resonance imaging, persistent clinical instability, or laxity on clinical exam...
December 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Adnan Saithna, Mathieu Thaunat, Jean Romain Delaloye, Hervé Ouanezar, Jean Marie Fayard, Bertrand Sonnery-Cottet
Background: Clinical results of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction have demonstrated a significant reduction in ACL graft rupture rates and improved rates of return to sports compared with isolated ACL reconstruction1 . This finding is supported by laboratory studies that have demonstrated that combined ACL reconstruction and lateral extra-articular tenodesis procedures protect the ACL graft by load-sharing with it and by more reliably restoring normal knee kinematics compared with isolated ACL reconstruction...
March 28, 2018: JBJS essential surgical techniques
Mattia Alessio-Mazzola, Matteo Formica, Antonio Russo, Francesca Sanguineti, Andrea Giorgio Capello, Stefano Lovisolo, Lamberto Felli
We report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score...
September 18, 2018: Journal of Knee Surgery
Tommaso Roberti di Sarsina, Luca Macchiarola, Cecilia Signorelli, Alberto Grassi, Federico Raggi, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini
PURPOSE: The aim of this study was to follow up, clinically and radiographically, skeletally immature patients who underwent ACL reconstruction with an all-epiphyseal "over-the-top" technique. METHODS: Twenty athletes aged between 8 and 13 years were enrolled and retrospectively evaluated. The subjects underwent surgical ACL reconstruction between 2009 and 2013. The surgical technique consisted of a single-bundle all-epiphyseal ACL reconstruction with an extra-articular lateral tenodesis...
September 12, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Frank R Noyes, Lauren E Huser, John West, Darin Jurgensmeier, James Walsh, Martin S Levy
PURPOSE: To determine the effect of 2 extra-articular reconstructions on pivot-shift rotational stability and tibial internal rotation as a basis for clinical recommendations. METHODS: A robotic simulator tested 15 cadaver knees. Group 1 (anterior cruciate ligament [ACL] cut) underwent ACL bone-patellar tendon-bone reconstruction followed by sectioning the anterolateral structures and an extra-articular, manual-tension iliotibial band (ITB) tenodesis. Group 2 (ACL intact) tested the rotational stabilizing effect of a low-tension ITB tenodesis before and after sectioning the anterolateral ligament/ITB structures...
September 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Alexander E Weber, William Zuke, Erik N Mayer, Brian Forsythe, Alan Getgood, Nikhil N Verma, Bernard R Bach, Asheesh Bedi, Brian J Cole
BACKGROUND: There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. PURPOSE: To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date...
February 1, 2018: American Journal of Sports Medicine
João Luiz Ellera Gomes, Murilo Anderson Leie, Marcos Marczwski, George Sánchez, Márcio Balbinotti Ferrari
An increasing concern has been given to the rotation stability of the knee in the setting of an anterior cruciate ligament (ACL) reconstruction. This growing interest stems from a better understanding of the rotational stability of the knee afforded by the identification of the anterolateral ligament. Previously, a residual abnormal pivot-shift test had been found after an anatomic single-band reconstruction of the ACL because of a lack of rotational stability, which may lead to the development of osteoarthritis...
October 2017: Arthroscopy Techniques
Patrick A Smith
Anterior cruciate ligament (ACL) graft failure rates remain unacceptably high in certain populations, and researchers are examining the effect that the anterolateral ligament (ALL) has on knee stability following ACL reconstruction. Currently, most available research examining the ALL has focused on cadaveric biomechanical kinematic studies, including the effect of surgical techniques for ALL reconstruction/lateral extra-articular tenodesis (LET). However, it is critical for ongoing and future research to focus on clinical outcome measures relating to individuals who have had ALL reconstruction or LET along with their ACL reconstructions...
January 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Simone Cerciello, Cécile Batailler, Nader Darwich, Philippe Neyret
Anterior cruciate ligament (ACL) reconstruction is a successful procedure with high rates of return to sport. However, some patients experience persistent instability and graft failure. These adverse events have a significant impact, especially on high-level athletes. In an effort to improve outcomes for these patients, more attention is being paid to the anatomic structures at the anterolateral aspect of the knee. The anterolateral structures of the knee have been shown to play a major role in decreasing rotatory knee instability and forces across the ACL graft following reconstruction...
January 2018: Clinics in Sports Medicine
Manoj Mathew, Aad Dhollander, Alan Getgood
Residual rotational laxity following anterior cruciate ligament (ACL) reconstruction has been identified as significant concern in many patients, despite evolution of techniques. The expanding body of knowledge on the anatomy and biomechanics of the anterolateral soft tissue restraints in rotational control of the knee has reignited an interest in extra-articular reconstruction techniques for augmenting ACL reconstruction. Reconstruction techniques currently used can be broadly categorized as either lateral extra-articular tenodesis or reconstruction of the anterolateral ligament...
January 2018: Clinics in Sports Medicine
Panagiotis Ntagiopoulos, David Dejour
Recent studies have renewed interest in the structures of the anterolateral aspect of the knee. Concomitant damage to these structures in the setting of anterior cruciate ligament rupture has led to various surgical techniques to address these combined injuries. This article is a description of the rationale and the indications for lateral extra-articular tenodesis as well as surgical technique.
January 2018: Clinics in Sports Medicine
Thomas K Miller
Patients who present for anterior cruciate ligament (ACL) revision with a high-grade pivot shift at the time of an index ACL revision procedure and subsequent reconstruction failure or a high-grade pivot shift at revision surgery, patients with generalized joint laxity, and those requiring softs tissue grafts should be considered candidates for lateral tenodesis to supplement intraarticular graft revision. Although there is no consensus regarding the optimal lateral tenodesis technique, due to the tibial positioning associated with tensioning and fixation of extra-articular procedures, a lateral tenodesis should not be used in patients with posterolateral corner injuries or lateral compartment articular disease...
January 2018: Clinics in Sports Medicine
Brian M Devitt, Stuart W Bell, Clare L Ardern, Taylor Hartwig, Tabitha J Porter, Julian A Feller, Kate E Webster
Background: The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial. Purpose: To determine whether the addition of LEAT to primary ACLR provides greater control of rotational laxity and improves clinical outcomes compared with ACLR alone and to assess the impact of early versus delayed ACLR. Study Design: Systematic review; Level of evidence, 3. Methods: Two reviewers independently searched 7 databases for randomized and nonrandomized clinical studies comparing ACLR plus LEAT versus ACLR alone...
October 2017: Orthopaedic Journal of Sports Medicine
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