Lateral Extra-articular Tenodesis Using a Double-Knotless, All-Suture Anchor for Onlay Fixation.

Abstract

Background: Lateral extra-articular augmentation procedures, including lateral extra-articular tenodesis (LET), are advocated in high-risk patients undergoing anterior cruciate ligament reconstruction (ACLR) to provide improved rotational stability and reduce rates of graft rupture postoperatively.

Indications: Indications for performing a LET concomitantly with ACLR continue to evolve, but are recommended for patients with certain demographics and in the presence of anatomic risk factors for graft rupture.

Technique description: After the ACL femoral tunnel is reamed, a lateral approach to the knee is performed, and an 8 cm long by 1 cm wide strip of the posterior iliotibial band is harvested and passed retrograde, deep to the lateral collateral ligament. While "tunneloscopy" is performed to confirm the absence of tunnel interference, a double-knotless, all-suture anchor is placed just proximal and posterior to the lateral epicondyle. After the ACL graft is passed and fixated, the limb is positioned in 30° of knee flexion and neutral tibial rotation. The double-knotless mechanism is then employed to achieve surface fixation of the LET graft.

Results: The literature suggests that performing a LET with ACLR improves rotational stability and reduces the rate of graft rupture postoperatively in high-risk patients, without deviating from standard ACLR postoperative protocols or causing additional morbidity at short- or midterm follow-up.

Discussion/conclusion: This article demonstrates a safe and reproducible method of performing a LET concomitantly with ACLR using a quadriceps autograft in appropriately indicated patients. Ongoing research continues to refine the indications and techniques for performing a LET with ACLR.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.