Summary

When and how do I perform a Primary ACL Reconstrucion with lateral extra articular augmentation?

Abstract

Introduction

Anterolateral rotational instability after anterior cruciate ligament (ACL) reconstruction surgery may be due a number of reasons, including tunnel misplacement, meniscal root tears, ramp lesions, total or subtotal meniscectomies, or disruption of anterolateral soft tissue structures. There is a great variety of lateral extra-articular tenodesis (LET) procedures that have been described following the initial technique described by Lemaire in 1967. There is no formal consensus nor clear indications so as to perform a LET procedure in primary ACL reconstruction surgery.

Purpose

Our aim is to describe our surgical technique, preventing pitfall tips, clinical outcomes evaluation and to discuss possible indications for this procedure.

Materials And Methods

We retrospectively analyzed 40 patients who underwent primary ACL reconstruction and lateral extra-articular augmentation between 2017 and 2019. The indications that this group considers to perform this combined procedure include 1 or + of the following: grade 3 Pivot Shift test (explosive Pivot Shift), high demand sports activity, associated segond fracture, Generalized ligamentous laxity or genu recurvatum of >10°, revision ACL surgery in the contra lateral knee.

Results

Average follow-up of 3.5 years (Range 2 to 5). IKDC test showed 75% of normal results, 20% of almost normal, and 5% of abnormal results. Despite these results, rotational stability was achieved in all patients.

Conclusion

Based on international references and our personal experience, it can be determined that the extra articular tenodesis improves antero-lateral rotational stability. It is highly recommended in the following situations: grade 3 Pivot Shift test (explosive Pivot Shift), high demand sports activity, associated segond fracture, Generalized ligamentous laxity or genu recurvatum of >10°, revision ACL surgery in the contra lateral knee.