lateral tenodesis

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...

In 2018, Letters to the Editor of Arthroscopy were heated and helped point out the broiling topics in our field including ankle arthroscopy distraction technique versus no-distraction and dorsiflexion, knee anterolateral ligament reconstruction versus lateral extraarticular tenodesis, hip labral primary repair versus primary reconstruction, and shoulder stabilization technique cost-effectiveness.

BACKGROUND: Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation. CASE SUMMARY: We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions...

BACKGROUND: Core outcome sets aim to select and standardize the choice of important outcomes reported in clinical trials to encourage more effective data synthesis, increase the reliability of comparing results, and minimize reporting bias. A core outcome set for elective shoulder surgery has yet to be defined, and therefore a systematic assessment of outcomes and methodology is necessary to inform the development of a core outcome set. QUESTIONS/PURPOSES: The purpose of this study was to examine randomized controlled trials (RCTs) of patients having elective major or minor shoulder surgery to (1) identify the outcome domains reported; (2) determine specific outcome measurement tools that were utilized; and (3) assess the work for methodological quality and risk of bias...

Reasons for failure of anterior cruciate ligament (ACL) reconstructions are manifold and require a multifactorial explanatory approach. In addition to technical failures, many modifiable and non-modifiable risk factors for a new ACL injury have to be considered. Technical failures primarily include non-anatomical tibial and femoral tunnel position. In comparison to the transtibial drilling technique, the tibial tunnel-independent technique results in a more anatomical position of the femoral tunnel and should therefore be preferred...

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...

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...

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...

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...

There is no ideal surgical technique for the treatment of acromioclavicular (AC) dislocations. Reconstruction of the coracoclavicular ligaments (CCLs) for the treatment of AC dislocations is evolving. Many techniques for CCL reconstruction have been described. They differ mainly in the method of fixation, number of tunnels, and graft used. The surgeon should select among hamstring autograft reconstruction, coracoacromial ligament transfer, and conjoint tendon transfer for CCL reconstruction. Early on, conjoint tendon transfer to the lateral clavicle was described for the treatment of high-grade AC dislocation...

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...

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...

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...

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...

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...

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...

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...

BACKGROUND: Anterolateral complex injuries are becoming more recognized. While these are known to affect tibiofemoral mechanics, it is not known how they affect patellofemoral joint behavior. PURPOSE: To determine the effect of (1) sectioning the anterolateral complex and (2) performing a MacIntosh tenodesis under various conditions on patellofemoral contact mechanics and kinematics. STUDY DESIGN: Controlled laboratory study. METHODS: Eight fresh-frozen cadaveric knees were tested in a customized rig, with the femur fixed and tibia free to move, with optical tracking to record patellar kinematics and with thin pressure sensors to record patellofemoral contact pressures at 0°, 30°, 60°, and 90° of knee flexion...

The injuries of the posterolateral corner (PLC) of the knee often remain misdiagnosed. Because most structures in this anatomical region have low potential to heal, the posterolateral rotational instability results in a deterioration in patient quality of life, impaired biomechanics of the knee, and increased tension on other ligaments and the meniscus. Many open and a few arthroscopic techniques have been developed to repair or reconstruct the damaged structures of the PLC. Creating an additional midlateral arthroscopic portal on the lateral side of the knee was the key to developing the technique to recreate a static stabilizer against external rotational instability of the PLC by fixing the popliteus tendon as a native, vascularized material to the tibia...

BACKGROUND: A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. The purpose of this meta-analysis was to compare different surgical techniques for management of chronic lateral ankle instability. METHODS: We searched the Cochrane Library, MEDLINE, and EMBASE. All identified randomized and quasi-randomized controlled trials of operative treatment for chronic lateral ankle instability were included. Two review authors independently extracted data from each study and assessed risk of bias...