Lateral Extra-articular Tenodesis Research Articles

Diagnostic Accuracy of Fine Needle Aspiration Cytology for Evaluation of Breast Lump Compared to Trucut Biopsy

Background: The primary issue after isolated intra-articular anterior cruciate ligament (ACL) surgery is the continuation of pivot shift. By limiting rotational laxity, the lateral extra-articular tenodesis (LET) treatment added to the ACL surgery improves knee stability. This study's objective was to assess the long-term clinical and radiological results of ACL restoration coupled with LET utilizing a continuous hamstring graft as the first operation. Method and Analysis: Four years postoperatively, 20 patients were examined. Collecting subjective outcome ratings (IKDC, Lysholm, KOOS, and Tegner). A clinical and radiological evaluation was conducted. The anteroposterior laxity of the knees was assessed using a rollimeter. Using SPSS version 23, the statistical analysis was conducted. The mean and standard deviation of quantitative data were used to summarize the data. Fischer's exact test was used to compare qualitative characteristics, whereas Student's t-test was used to compare mean values. A p value of 0.05 or less was regarded as significant. Result: The mean IKDC subjective score was 83.1, the mean Lysholm score was 89.02 and 75% of patients had exceptional or excellent scores. In 85% of patients, there was no pivot shift, and 60% of patients had a definitive endpoint on the Lachman test. Conclusion: The addition of primary LET to ACL restoration enhances rotational laxity control over time without raising the risk of complications.

Clinical Outcome of Arthroscopic Reconstruction of ACL with Lateral Extra-Articular Tenodesis (Let) to Reduce Anterolateral Rotatory Laxity

A gallstone ileus is a rare cause of intestinal obstruction, caused by the migration of a gallstone through an entero-biliary fistula and its impact in the digestive system, most often in the ileocecal valve. We report here the case of a 60-year-old woman who was admitted for a biliary ileus at the sigmoid level, which is an even rarer cause of intestinal obstruction. The fistula was located between the colon and the gallbladder. The gallstone was surgically removed by colotomy, without treating the fistula and afterwards. The follow-up was without complications. Surgical closure of an enterobiliary fistula is an option that should be considered, but it may result in higher morbidity. Therefore, we chose not to do it, especially considering that spontaneous fistula closure can occur.

Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return-to-Sport Rate to Anterior Cruciate Ligament Reconstruction Alone but a Lower Failure Rate

To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) would improve return-to-sport (RTS) rates in young, active patients who play high-risk sports. This multicenter randomized controlled trial compared standard hamstring tendon ACLR with combined ACLR and LET using a strip of the iliotibial band (modified Lemaire technique). Patients aged 25 years or younger with an anterior cruciate ligament-deficient knee were included. Patients also had to meet 2 of the following criteria: (1) pivot-shift grade 2 or greater, (2) participation in a high-risk or pivoting sport, and (3) generalized ligamentous laxity. Time to return and level of RTS were determined via administration of a questionnaire at 24 months postoperatively. We randomized 618 patients in this study, 553 of whom played high-risk sports preoperatively. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR-LET (14%) groups; however, the graft rupture rate was significantly different (11.2% in ACLR group vs 4.1% in ACLR-LET group, P= .004). The most cited reason for no RTS was lack of confidence and/or fear of reinjury. A stable knee was associated with nearly 2 times greater odds of returning to a high-level high-risk sport postoperatively (odds ratio, 1.92; 95% confidence interval, 1.11-3.35; P= .02). There were no significant differences in patient-reported functional outcomes or hop test results between groups (P > .05). Patients who returned to high-risk sports had better hamstring symmetry than those who did not RTS (P= .001). At 24 months postoperatively, patients who underwent ACLR plus LET had a similar RTS rate to those who underwent ACLR alone. Although the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates. Level I, randomized controlled trial.

Repair Of the ACL and Anterolateral Structures Versus Reconstruction and Lateral Extra-Articular Tenodesis: A Prospective Comparative Study of Acute ACL-Injured Knees

Repair Of the ACL and Anterolateral Structures Versus Reconstruction and Lateral Extra-Articular Tenodesis: A Prospective Comparative Study of Acute ACL-Injured Knees

Adolescent Patients Experience Significantly Lower ACL Graft Rupture Rates When ACL Reconstruction is Combined with Lateral Extra-Articular Tenodesis: A Comparison Against Outcomes of Isolated ACL Reconstruction

Adolescent Patients Experience Significantly Lower ACL Graft Rupture Rates When ACL Reconstruction is Combined with Lateral Extra-Articular Tenodesis: A Comparison Against Outcomes of Isolated ACL Reconstruction

Isolated Lateral Extra-articular Tenodesis (LEAT) for Chronic Rotational Instability following Primary Anterior Cruciate Ligament (ACL) Reconstruction has Low Surgical Morbidity and Improves Knee Stability

Isolated Lateral Extra-articular Tenodesis (LEAT) for Chronic Rotational Instability following Primary Anterior Cruciate Ligament (ACL) Reconstruction has Low Surgical Morbidity and Improves Knee Stability

Almost Four Times Lower Failure Rate When Adding a Lateral Extra Articular Tenodesis in the Setting of Revision ACL-R after 4 A Mean of Years Follow-Up

Almost Four Times Lower Failure Rate When Adding a Lateral Extra Articular Tenodesis in the Setting of Revision ACL-R after 4 A Mean of Years Follow-Up

Lateral Extra-Articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Does Not Impact Cartilage health in the patellofemoral joint based on post-operative two year qualitative and quantitative MRI analysis

Lateral Extra-Articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Does Not Impact Cartilage health in the patellofemoral joint based on post-operative two year qualitative and quantitative MRI analysis

Concomitant Lateral Meniscus Tear in the Anterior Cruciate Ligament Injured Knee Should Be Treated by Repair or Additional Lateral Extraarticular Tenodesis to Achieve Sufficient Stability

Concomitant Lateral Meniscus Tear in the Anterior Cruciate Ligament Injured Knee Should Be Treated by Repair or Additional Lateral Extraarticular Tenodesis to Achieve Sufficient Stability

More Severe Adverse Events are Associated with Worse Patient Reported Outcome Measures Following Anterior Cruciate Ligament Reconstruction with and Without Lateral Extra-Articular Tenodesis Augmentation - Results from the Stability Randomized Trial

More Severe Adverse Events are Associated with Worse Patient Reported Outcome Measures Following Anterior Cruciate Ligament Reconstruction with and Without Lateral Extra-Articular Tenodesis Augmentation - Results from the Stability Randomized Trial

Clinical Outcomes and Failure Rates in Patients Undergoing Revision ACLR With or Without Modified Lemaire Lateral Extra-Articular Tenodesis

Clinical Outcomes and Failure Rates in Patients Undergoing Revision ACLR With or Without Modified Lemaire Lateral Extra-Articular Tenodesis

Modified Lemaire Tenodesis Forces in Cadaveric Specimens Are Not Affected by Random Small-Scale Variations in the Femoral Insertion Point During Active Knee Joint Flexion-Extension

PurposeTo directly measure lateral extra-articular tenodesis (LET) forces supporting anterior cruciate ligament reconstruction (ACLR) during dynamic flexion-extension cycles induced by simulated active muscle forces, to investigate the influence of random surgical variation in the femoral LET insertion point around the target insertion position, and to determine potential changes to the extension behavior of the knee joint in a cadaveric model.MethodsAfter iatrogenic anterior cruciate ligament deficiency and simulated anterolateral rotatory instability, 7 fresh-frozen cadaveric knee joints were treated with isolated ACLR followed by combined ACLR-LET. The specimens were tested on a knee joint test bench during active dynamic flexion-extension with simulated muscle forces. LET forces and the degree of knee joint extension were measured. Random variation in the LET insertion point around the target insertion position was postoperatively quantified by computed tomography.ResultsIn extension, the median LET force increased to 39 ± 2 N (95% confidence interval [CI], 36 to 40 N). In flexion over 70°, the LET was offloaded (2 ± 1 N; 95% CI, 0 to 2 N). In this study, small-scale surgical variation in the femoral LET insertion point around the target position had a negligible effect on the graft forces measured. We detected no difference in the degree of knee joint extension after combined ACLR-LET (median, 1.0° ± 3.0°; 95% CI, −6.2° to 5.2°) in comparison with isolated ACLR (median, 1.1° ± 3.3°; 95% CI, −6.7° to 6.1°; P = .62).ConclusionsLET forces in combined ACLR-LET increased to a limited extent during active knee joint flexion-extension independent of small-scale variation around 1 specific target insertion point. Combined ACLR-LET did not change knee joint extension in comparison with isolated ACLR under the testing conditions used in this biomechanical study.Clinical RelevanceLow LET forces can be expected during flexion-extension of the knee joint. Small-scale deviations in the femoral LET insertion point around the target insertion position in the modified Lemaire technique might have a minor effect on graft forces during active flexion-extension. To directly measure lateral extra-articular tenodesis (LET) forces supporting anterior cruciate ligament reconstruction (ACLR) during dynamic flexion-extension cycles induced by simulated active muscle forces, to investigate the influence of random surgical variation in the femoral LET insertion point around the target insertion position, and to determine potential changes to the extension behavior of the knee joint in a cadaveric model. After iatrogenic anterior cruciate ligament deficiency and simulated anterolateral rotatory instability, 7 fresh-frozen cadaveric knee joints were treated with isolated ACLR followed by combined ACLR-LET. The specimens were tested on a knee joint test bench during active dynamic flexion-extension with simulated muscle forces. LET forces and the degree of knee joint extension were measured. Random variation in the LET insertion point around the target insertion position was postoperatively quantified by computed tomography. In extension, the median LET force increased to 39 ± 2 N (95% confidence interval [CI], 36 to 40 N). In flexion over 70°, the LET was offloaded (2 ± 1 N; 95% CI, 0 to 2 N). In this study, small-scale surgical variation in the femoral LET insertion point around the target position had a negligible effect on the graft forces measured. We detected no difference in the degree of knee joint extension after combined ACLR-LET (median, 1.0° ± 3.0°; 95% CI, −6.2° to 5.2°) in comparison with isolated ACLR (median, 1.1° ± 3.3°; 95% CI, −6.7° to 6.1°; P = .62). LET forces in combined ACLR-LET increased to a limited extent during active knee joint flexion-extension independent of small-scale variation around 1 specific target insertion point. Combined ACLR-LET did not change knee joint extension in comparison with isolated ACLR under the testing conditions used in this biomechanical study.

Femoral-Physeal-Sparing ACL Reconstruction With Lateral Extra-articular Tenodesis and Inside-Out Repair of Lateral Meniscus in a Skeletally Immature Patient

Background: Anterior cruciate ligament (ACL) reconstructions in skeletally immature patients have an increased risk of graft failure and a decreased rate of successful return to sports. Anterior cruciate ligament reconstructions (ACLRs) combined with lateral extra-articular tenodesis (LET) procedures are reported to limit anterolateral rotary instability of the knee, decreasing tension on the ACL graft. However, the open physes found in pediatric patients present unique challenges for ACLR. This video demonstrates a technique to avoid the femoral physis and necessary precautions for performing an ACLR with LET in a skeletally immature patient. Indications: The indications for combined ACLR and LET, as opposed to ACLR alone, mainly center on the risk factors for graft failure. These include the following: posterior tibial slope >12°, revision ACLR, high-grade pivot shift on physical examination, meniscal deficiency, generalized ligamentous hyperlaxity, and—especially pertinent to this procedure—skeletally immature patients. Technique Description: Standard plain radiographs and long-leg alignment films, along with a magnetic resonance imaging (MRI) study, are necessary to assess for malalignment, bone age, and concomitant meniscal and chondral pathology. This technique describes the senior author’s preferred technique for pediatric ACLR with LET. The senior author’s preferred order of operations includes performing the autologous hamstring graft harvest and LET before performing the diagnostic arthroscopy. This is followed by the intra-articular work including the ACLR. It is also the senior author’s preference to perform physeal-sparing femoral tunnels, using fluoroscopy for tunnel placement. Results: Getgood et al reported that an ACLR with an LET in young patients with a high risk of graft failure had a significant reduction in graft rupture compared to an ACLR alone. Furthermore, Noyes et al reported a significantly lower rate of graft failure and a higher rate of return to sports in those who received LET in addition to ACLR compared with those who received ACLR alone. Discussion: An ACLR combined with an LET has been reported to reduce graft failure rates and improve clinical outcomes in high-risk patients. An ACLR with LET may also be considered in skeletally immature patients with appropriate indications and extra precautions to avoid growth arrest or deformity. 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.

Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction.

There is evidence on the clinical effectiveness of the Lemaire technique for lateral extra-articular tenodesis (LET) in patients undergoing revision anterior cruciate ligament reconstruction (ACLR), but the best fixation technique is unknown. To compare the clinical outcomes of 2 fixation techniques after revision ACLR: (1) onlay anchor fixation, which would avoid tunnel conflict and physis injury, and (2) transosseous tightening and interference screw fixation. Pain at the area of LET fixation was also assessed. Cohort study; Level of evidence, 3. This was a retrospective 2-center study of patients with first-time revision ACLR and either LET with anchor fixation (aLET) with a 2.4-mm suture anchor or LET with transosseous fixation (tLET). Outcomes at minimum 12-month follow-up were assessed with the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain at the LET fixation area, Tegner score, and anterior tibial translation (ATT). A subgroup analysis within the aLET group investigated passing the graft over or under the lateral collateral ligament (LCL). In total, 52 patients were included (26 patients in each group); the mean ± SD follow-up was 13.7 ± 3.4 months. No statistically significant differences were detected between the groups with respect to patient-reported outcome scores, clinical examination, or instrumented testing (side-to-side difference in ATT at 30° of flexion; aLET, 1.5 ± 2.5 mm; tLET, 1.6 ± 1.7 mm). Clinical failure was detected in 1 patient with aLET and none with tLET. Subgroup analysis revealed a small, nonsignificant flexion deficit in knees in which the iliotibial band strand was passed under (n = 42) or over (n = 10) the LCL. No clinically relevant tenderness was detected at the area of LET fixation in any group (aLET, 0.6 ± 1.3; tLET, 0.9 ± 1.7; over the LCL, 0.2 ± 0.6; under the LCL, 0.9 ± 1.6). Onlay anchor fixation and transosseous fixation of the LET were equivalent with respect to outcome scores and instrumented ATT testing. Clinically, there were minor differences in passage of the LET graft over or under the LCL.

Femoral Physeal-Sparing ACL Reconstruction With Iliotibial Band Autograft Over-the-Top With Associated Lateral Extra-Articular Tenodesis

Background: Injuries to the anterior cruciate ligament (ACL) in the pediatric population have been exponentially increasing over the years. However, surgical techniques typically employed for ACL reconstruction (ACL-R) in adults may injure the physes of skeletally immature patients, resulting in growth disturbances. Indications: Currently, ACL-R is recommended for most patients, aiming to return the patient to their previous activities as well as reduce the risk of further instability, meniscal and chondral injuries, and early osteoarthritis. Pediatric ACL-R techniques may vary widely. In this video, the technique chosen was over-the-top on the femur with a vertical tibial tunnel, in addition to a lateral extra-articular tenodesis, using the iliotibial (IT) band as the graft. Technique Description: The patient is positioned in standard supine arthroscopic position. An incision is made over the lateral epicondyle and the IT band is exposed. A 2-cm-wide graft is harvested. The proximal aspect of the graft is truncated as high as possible, and the distal aspect is left attached to Gerdy tubercle. Arthroscopic portals are established, and the remanent ACL is debrided, exposing the posterior aspect of the lateral femoral condyle. The capsule is penetrated using a Schnidt tonsil to establish the over-the-top position, which is subsequently exchanged for a cardiac clamp. The graft sutures are grasped using the clamp and pulled into the joint. The tibial tunnel is drilled at the anatomic footprint of the ACL. The graft is threaded over-the-top of the lateral femoral condyle and through the tibial tunnel. Finally, femoral graft fixation is performed on the lateral femoral condyle using interrupted sutures through the IT band and periosteum, and tibial graft fixation is performed with standard interference fixation. Results: Previous literature shows low re-rupture rates, excellent postoperative patient-reported outcomes, and high return to sport rates. Conclusion: In the pediatric population, there is still no ACL-R technique defined as the gold standard. The described technique is a valuable option for ACL-R in skeletally immature patients, with low revision rates and excellent postoperative outcomes. In addition, this technique minimizes the risk of growth disturbances and effectively stabilizes the knee, allowing patients to return to previous activities. 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.

AB100. SOH23ABS_001. Lateral extra-articular tenodesis versus anterolateral ligament reconstruction lateral augmentation for primary anterior cruciate ligament reconstruction with minimum 2-year follow-up: a systematic review and meta-analysis

AB100. SOH23ABS_001. Lateral extra-articular tenodesis versus anterolateral ligament reconstruction lateral augmentation for primary anterior cruciate ligament reconstruction with minimum 2-year follow-up: a systematic review and meta-analysis

Anatomical Landmark Technique for Femoral Tunnel Placement of Lateral Extra-Articular Tenodesis

The anterolateral ligament is a crucial part of the anterolateral complex of the knee, providing rotator stability to the knee and being a primary restraint to tibial internal rotation. Lateral extra-articular tenodesis added to anterior cruciate ligament reconstruction can reduce pivot shift without sacrificing the range of motion or increasing the risk of osteoarthritis. A 7- to 8-cm longitudinal skin incision is made and a 9.5- to 10-cm × 1- cm wide iliotibial band graft is dissected, leaving the distal attachment intact. The free end is whip stitched. One of the most important steps during the procedure is the identification of the site of attachment of the iliotibial band graft. The leash of vessels, fat pad, lateral supracondylar ridge, and fibular collateral ligament serve as important landmarks. The tunnel is drilled from the lateral femoral cortex with a guide pin and reamer pointing 20 to 30° anteriorly and proximally while the arthroscope visualizes the femoral anterior cruciate ligament tunnel. The graft is routed under the fibular collateral ligament. The graft is fixed with a bioscrew while the knee is kept in 30° flexion and the tibia is kept in neutral rotation. We believe that lateral extra-articular tenodesis gives the anterior cruciate ligament graft a good chance for faster healing along with addressing anterolateral rotatory instability. Choosing a correct fixation point is very important to restore normal knee biomechanics.

Lateral Extra-articular Tenodesis with Iliotibial Band Using Knotless All-Suture Anchor Femoral Fixation

Common injuries, such as anterior cruciate ligament (ACL) tears, can result in both anterior and rotational instability of the knee. An arthroscopic anterior cruciate ligament reconstruction (ACLR) method has been shown to be effective in restoring anterior translational stability, but this could be followed by persistent rotational instability by means of residual pivot shifts or repeat instability episodes. Alternative techniques, such as a lateral extraarticular tenodesis (LET), has been proposed as a technique for preventing persistent rotational instability following ACLR. This article presents a case of a LET using an autologous central slip of iliotibial (IT) band with fixation to the femur using a 1.8-mm knotless all-suture anchor.

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

BackgroundMost athletes who undergo revision of the anterior cruciate ligament reconstruction (ACLR) aim to return to their preinjury sport at a similar level of performance while minimizing the risk for reinjury. Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved outcomes and low complication rate. Yet, there are few series evaluating return-to-sport (RTS) and clinical outcomes after revision ACLR using bone-patellar tendon-bone (BPTB) and LET in athletes.MethodsThe study cohort consisted of 19 eligible athletes who had undergone their first revision ACLR using BPTB and LET (modified Lemaire) between January 2019 and 2020. Patients were prospectively followed and interviewed in a sports activity survey during a 2-year follow-up.ResultsDespite all patients returning to sports after revision ACLR surgery, 52.6% resumed playing at their preinjury level. Furthermore, patient-reported functional outcomes improved significantly following revision surgery, as evidenced by improvements in IKDC [64.4 (± 12) to 87.8 (± 6)], Lysholm [71.27 (± 12) to 84.2 (± 9.7)], and SF-12 scales [Physical: 53.3 (± 3) 57 (± 1.2); Mental: 50.2 (± 3.3) to 52.7 (± 2.4)]. One case (5.3%) experienced persistent pain and underwent reoperation for a partial meniscectomy.ConclusionAfter revision ACLR using autologous BPTB and LET, all active individuals are expected to RTS, similar to primary ACLR. The difference comes down to returning to the preinjury level, where the levels are lower depending on the sport and initial level of play. Good mid-term functional outcomes with a low complication rate can be expected in most cases.Study designCase series; Level of evidence IV.Ethical Committee Approval NumberPR(ATR)79/2021 and HCB/2023/0173.

Development and Preliminary Validation of the KOOS-ACL: A Short Form Version of the KOOS for Young Active Patients With ACL Tears

Background: The Knee injury and Osteoarthritis Outcomes Score (KOOS) is a widely used region-specific outcome measure for assessing patients of all ages with a variety of knee conditions. Use of the KOOS for young active patients with anterior cruciate ligament (ACL) tear has been called into question regarding its relevance and interpretability for this specific population. Furthermore, the KOOS does not have adequate structural validity for use in high-functioning patients with ACL deficiency. Purpose: To develop a condition-specific short form version of the KOOS that is appropriate for the young active population with ACL deficiency: the KOOS-ACL. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A baseline data set of 618 young patients (≤25 years old) with ACL tears was divided into development and validation samples. Exploratory factor analyses were conducted in the development sample to identify the underlying factor structure and to reduce the number of items based on statistical and conceptual indicators. Confirmatory factor analyses were conducted to check fit indices of the proposed KOOS-ACL model in both samples. Psychometric properties of the KOOS-ACL were assessed using the same data set, expanded to include patient data from 5 time points (baseline and postoperative 3, 6, 12, and 24 months). Internal consistency reliability, structural validity, convergent validity, responsiveness to change, floor/ceiling effects, and detection of treatment effects between surgical interventions (ACL reconstruction alone vs ACL reconstruction + lateral extra-articular tenodesis) were assessed. Results: A 2-factor structure was deemed most appropriate for the KOOS-ACL. Of 42 items, 30 were removed from the full-length KOOS. The final KOOS-ACL model showed acceptable internal consistency reliability (α = .79-.90), structural validity (comparative fit index and Tucker-Lewis index = 0.98-0.99; root mean square error of approximation and standardized root mean square residual = 0.04-0.07), convergent validity (Spearman correlation with International Knee Documentation Committee subjective knee form = 0.61-0.83), and responsiveness across time (significant small to large effects; P < .05). Conclusion: The new KOOS-ACL questionnaire contains 12 items and 2 subscales—Function (8 items) and Sport (4 items)—relevant to young active patients with an ACL tear. Use of this short form would reduce patient burden by more than two-thirds; it provides improved structural validity as compared with the full-length KOOS for our population of interest; and it demonstrates adequate psychometric properties in our sample of young active patients undergoing ACL reconstruction.