Anterolateral Ligament Reconstruction or Extra-Articular Tenodesis

Mathew, Manoj; Dhollander, Aad; Getgood, Alan

doi:10.1016/j.csm.2017.07.011

Cited by 43 publications

(35 citation statements)

References 47 publications

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“…Of those patients randomized to receive LET, surgeons used a modified Lemaire technique ( Figure 1). 34 An oblique skin incision was made between the lateral femoral epicondyle and Gerdy tubercle, measuring approximately 5 cm. A 1 3 8-cm strip was harvested from the ITB, leaving the attachment at the Gerdy tubercle intact.…”

Section: Study Treatmentsmentioning

confidence: 99%

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Getgood¹,

Bryant²,

Litchfield³

et al. 2020

Am J Sports Med

409

439

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Background: Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure. Hypothesis: We hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active individuals. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk/pivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively. Results: A total of 618 patients (297 males; 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction [RRR], 0.38; 95% CI, 0.21-0.52; P < .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67; 95% CI, 0.36-0.83; P < .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 ( P = .003) and KOOS ( P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months ( P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale ( P = .11). Conclusion: The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery. Registration: NCT02018354 ( ClinicalTrials.gov identifier)

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Section: Study Treatmentsmentioning

confidence: 99%

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Getgood¹,

Bryant²,

Litchfield³

et al. 2020

Am J Sports Med

409

439

View full text Add to dashboard Cite

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“…The anterolateral knee soft tissues are composed of the anterolateral capsular ligament (i.e. the ALL) and ITB, with its deep Kaplan fibers spreading to the lateral meniscal insertion, distal femur, and joint capsule 23 . Engebretsen et al 30 .…”

Section: Discussionmentioning

confidence: 99%

“…They have reported improved knee stability and patient-reported outcomes (PROs) 14, 15, 16, 17, 18, 19, 20, 21, 22. The anterolateral knee structures are composed of the ALL and iliotibial band (ITB), especially its deep fibers, also known as the Kaplan fibers 23 . It has also been reported that the ITB is injured in 93% of cases of ACL-deficient knees 6 .…”

mentioning

confidence: 99%

Lateral Extra-articular Tenodesis With Proximal Staple Fixation

Kwapisz

Mollison

McRae

et al. 2019

Arthroscopy Techniques

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A technique for lateral extra-articular tenodesis using proximal staple fixation is described as an adjunct to anterior cruciate ligament (ACL) reconstruction. Lateral extra-articular tenodesis has been used in an effort to decrease failure rates in ACL-deficient patients with ligamentous laxity, prior failed ACL surgery, or grade 3 pivot-shift findings. Numerous surgeons have described combining ACL reconstruction with extra-articular surgery. The approach described in this article is easy and cost-effective. Moreover, because this technique uses a staple instead of a SwiveLock (Arthrex, Naples, FL) or other suture anchor, it limits the chance of conflicting with the tunnels for the ACL because there is no need to drill or punch additional tunnels.

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“…Controversy was found regarding anatomy, 1,2,4-6 histology, 7-9 biomechanics, [10][11][12][13] radiological evaluation, [14][15][16][17][18][19][20] and reconstruction techniques. [21][22][23][24][25] Even though we have some data showing the benefits of ALL reconstruction, [26][27][28][29][30] it is not an absolute truth for most knee surgeons. But, as pointed out recently by Rossi in an Arthroscopy editorial (and matching my personal opinion), "The story is not any more 'if' augmentation should be considered but 'when' and, maybe more important, 'how' to augment."…”

Section: See Related Article On Page 2152mentioning

confidence: 99%

Editorial Commentary: Extension of Knowledge—and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near Extension

Helito¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The knee anterolateral ligament (ALL) is one of the most hotly debated topics in sports medicine in the last decade. Once one aspect of discussion regarding the ALL reaches a consensus, attention immediately turns to the next one. This has already happened with the existence of the ALL itself, its anatomic features, the ability to visualize the ALL with magnetic resonance imaging, and many other topics. In the end, the most important aspect must be clinical outcomes, and existing studies are trying to find the optimum surgical technique to best restore knee stability and reduce failure rates. It appears that, when doing an anatomic ALL reconstruction, fixation must be performed in full extension. The literature regarding ALL reconstruction shows promising results, with a strong tendency to present better knee stability, improved functional scores, and lower failure rates.

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Anterolateral Ligament Reconstruction or Extra-Articular Tenodesis

Cited by 43 publications

References 47 publications

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Lateral Extra-articular Tenodesis With Proximal Staple Fixation

Editorial Commentary: Extension of Knowledge—and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near Extension

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