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Lateral Extra-articular Tenodesis: A Technique With an Iliotibial Band Strand Without Implants.

ABSTRACT: The main goal in anterior cruciate ligament reconstruction (ACLR) should be to restore normal knee biomechanics so the chances of failure decrease. The persistence of knee instability after ACLR goes from 0.7% to 20%. Several factors have been identified and studied, but there are some selected cases in which it seems that without adding lateral extra-articular tenodesis (LET) it is not possible to control rotational instability. Data exist supporting that LET could reduce pivot shift (PS), without losing flexion/extension range of motion nor adding risk of osteoarthritis. Recently, LET has been used in addition to ACLR to add restriction to internal tibial rotation forces, and different authors have shown their techniques to achieve this task. Also, biomechanical studies have compared different techniques for LET procedures. This article aims to describe our technique performing a modified Macintosh LET as an addition to ACLR in selected patients who require extra internal tibial rotation control. This is a reproducible, easy to learn, and inexpensive procedure in terms that only a high resistance suture is needed and not any other implant, such as a stapler, anchors, or screws, reducing the risk of tunnel coalition.

SUBMITTER: Abusleme S

PROVIDER: S-EPMC7823113 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Tibial anterolateral rotary instability associated with anterior cruciate ligament (ACL) tears is a well-documented and difficult problem with a long history of solutions. The lateral extra-articular tenodesis (LET) has undergone multiple refinements in technique, largely focusing on the femoral site insertion using either an interference screw versus a staple for adequate fixation. In this article, we present an improved technique using a suture anchor as an alternative to a staple or an interference screw with secure fixation to insert the LET graft onto the femur. This technique diminishes the chance of ACL tunnel–LET drilling convergence, minimizes the footprint required for adequate graft fixation, and allows the surgeon to dial in the correct tension necessary for adequate augmentation of an ACL reconstruction. Technique Video Video 1 Onlay technique of lateral extra-articular tenodesis (LET). The lateral aspect of a right knee is shown, with the patient positioned supine. The surgeon performs an approach to the iliotibial band, removing all subcutaneous tissue for adequate exposure starting approximately at the Gerdy tubercle and extending proximally about 8 cm. A distally based strip of the iliotibial band is harvested, approximately 1 cm in width, by use of separate incisions. A double-loaded 2.3-mm Iconix all-suture suture anchor is used for LET graft insertion. The graft is whipstitched with an arm of the suture anchor that is first passed underneath the lateral collateral ligament, followed by a simple suture pass through the graft by the other end of the same arm of the suture attached to the suture anchor. The fixation with 1 arm of the double-loaded Iconix suture anchor was enough to secure the graft appropriately, and the other suture within the double-loaded 2.3-mm Iconix suture anchor was removed prior to definitive fixation of the LET graft. Once the LET graft was appropriately stitched, the graft was passed underneath the lateral collateral ligament again, from distal to proximal, and then secured to the Iconix suture anchor.

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Lateral Extra-articular Tenodesis: A Technique With an Iliotibial Band Strand Without Implants.

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