A lateral extra-articular tenodesis without additional hardware: Surgical technique and biomechanical comparison with an anatomic anterolateral ligament reconstruction in the augmentation of anterior cruciate ligament reconstruction

Samuel K Van de Velde; Scott Telfer; Ewoud R A van Arkel; Gregory A Schmale

doi:10.1016/j.knee.2024.02.003

A lateral extra-articular tenodesis without additional hardware: Surgical technique and biomechanical comparison with an anatomic anterolateral ligament reconstruction in the augmentation of anterior cruciate ligament reconstruction

Knee. 2024 Feb 22:47:112-120. doi: 10.1016/j.knee.2024.02.003. Online ahead of print.

Authors

Samuel K Van de Velde¹, Scott Telfer², Ewoud R A van Arkel³, Gregory A Schmale⁴

Affiliations

¹ Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA; Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Orthopedic Surgery, Seattle Children's Hospital, Seattle, WA, USA. Electronic address: sv2647@cumc.columbia.edu.
² Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
³ Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands.
⁴ Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Orthopedic Surgery, Seattle Children's Hospital, Seattle, WA, USA.

PMID: 38394990
DOI: 10.1016/j.knee.2024.02.003

Abstract

Background: The aims of this study were to describe a lateral extra-articular tenodesis (LET) using no additional hardware and compare the tibiofemoral kinematics of anterior cruciate ligament (ACL) reconstruction augmented with either the LET or a standard anatomic anterolateral ligament (ALL) reconstruction using intra-tunnel fixation.

Methods: Ten cadaveric knees were mounted on a robotic testing system and underwent a kinematic assessment of anterior tibial translation and internal tibial rotation under a simulated pivot-shift in the following states: ACL-intact, ACL-sectioned, ACL-sectioned/anterolateral complex (ALC)-sectioned, ACL-reconstructed/ALC-sectioned, ACL-reconstructed/ALL-reconstructed, and ACL-reconstructed/LET. For the LET, an iliotibial autograft was passed under the fibular collateral ligament and secured to the femur with the pull sutures of the ACL reconstruction femoral cortical suspensory fixation device, positioned at the distal ridge of Kaplan's fibers.

Results: Anterior tibial translation was restored to normal by ACL reconstruction without meaningful benefit of augmentation with LET or ALL. ACL reconstruction restored internal tibial rotation close to normal between 0° and 30°, but increased internal tibial rotation persisted between 45° and 90°. Augmentation of ACL reconstruction with the LET reduced internal rotation close to normal between 45° and 90°, whereas increased internal rotation persisted after ALL reconstruction.

Conclusion: ACL reconstruction and LET are complementary in controlling tibiofemoral kinematics of knees with a combined ACL and ALC injury: ACL reconstruction restored native tibiofemoral kinematics except for internal rotation at flexion greater than 30°. The increased internal rotation at flexion greater than 30° was restored to normal with an LET, but not with an ALL reconstruction.

Keywords: Anterolateral ligament (ALL); Lateral extra-articular tenodesis (LET); all-inside anterior cruciate ligament (ACL) reconstruction; anterolateral complex (ALC); anterolateral rotatory instability (ALRI).