Consideration of lateral augmentation in anatomic anterior cruciate ligament reconstruction

Anatomic intra-articular anterior cruciate ligament reconstruction (ACLR) techniques have been shown to reliably correct anteroposterior (translational) stability; however, they have failed to restore normal tibial rotational kinematics. Re-establishing rotational stability correlates with return to sport, functional scores, overall knee function and patient satisfaction. Several structures in addition to the ACL have been identified as important contributors to rotational knee stability. Recent interest in the anatomical and biomechanical properties of the anterolateral soft tissue structures has led to a resurgence in surgical techniques, specifically anterolateral ligament (ALL) reconstruction and lateral extra-articular tenodesis (LET), to address rotational stability at the time of ACL reconstruction. In the accompanying review we outline the relevant anatomy, biomechanics and clinical results for lateral augmentation procedures; discuss the indications and describe our preferred LET technique for lateral augmentation.