McGovern Madeline M, Yalcin Sercan, Lowenstein Natalie A, Mazzocca Jillian L, Matzkin Elizabeth G, Medina Giovanna
Mass General Brigham, Department of Orthopaedics, Harvard Medical School, Boston, Massachusetts, USA.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Video J Sports Med. 2025 Jan 22;5(1):26350254241282692. doi: 10.1177/26350254241282692. eCollection 2025 Jan-Feb.
Lateral extra-articular tenodesis (LET) is a surgical technique used to decrease the risk of anterior cruciate ligament reconstruction (ACLR) failure by supplementing internal rotational stability and reducing pivot shift.
A growing body of literature indicates that LET should be performed for patients under 25 years, those with increased posterior tibial slope and ligamentous laxity, and elite athletes in cutting and/or pivoting sports. Additional indications include patients with grade 2 pivot shift or greater and those with a history of anterior cruciate ligament graft failure.
Surgeon preference determines LET and ACLR sequence. Anatomic landmarks are identified and marked. A 5-cm incision is made in line with the iliotibial (IT) band from Gerdy's tubercle toward the lateral epicondyle. Dissection is carried to the IT band. Approximately 1 cm from the posterior border of the IT band, a full-thickness graft of 7 to 8 cm in length and 1 cm in width is harvested proximally and then whipstitched. A varus stress applies ligamentous tension and aids in lateral collateral ligament (LCL) identification. The LCL is dissected out, and the graft is passed underneath it. An all-suture anchor placed approximately 1 to 2 cm proximal and posterior to the lateral epicondyle and the knee is positioned in neutral rotation and at approximately 60° of flexion. The graft is passed inside the suture loop with an additional knot tied over the top using the needled suture. The IT band is then repaired side to side. Remaining subcutaneous tissue and skin are closed in standard fashion based on the order of the surgery.
In the STABILITY randomized controlled trial, 2-year outcomes demonstrated a clinically and statistically significant decrease in clinical failure from 40% to 25% and graft rupture rate from 11% to 4% with the addition of LET to ACLR with hamstring autograft. Similar return-to-sport rate was seen between cohorts. A meta-analysis of 6 studies examining ACLR versus ACLR + LET in individuals undergoing primary ACLR reported a reduced incidence of graft failure and postoperative anterolateral rotatory instability.
DISCUSSION/CONCLUSION: LET is a technique that can help reduce the risk of ACLR failure. Our technique employs a knotless suture anchor to confer anterolateral rotatory stability in the setting of ACLR.
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.
外侧关节外肌腱固定术（LET）是一种外科技术，通过增强内旋稳定性和减少轴移来降低前交叉韧带重建（ACLR）失败的风险。
越来越多的文献表明，25岁以下的患者、后胫骨坡度增加和韧带松弛的患者以及从事切入和/或旋转运动的精英运动员应进行LET手术。其他适应症包括2级或更高级别的轴移患者以及有前交叉韧带移植失败史的患者。
手术顺序由外科医生的偏好决定。识别并标记解剖标志。从Gerdy结节向外侧髁沿髂胫束（IT）做一条5厘米的切口。解剖至IT束。在距IT束后缘约1厘米处，近端取一段长7至8厘米、宽1厘米的全层移植物，然后进行锁边缝合。施加内翻应力以产生韧带张力并有助于识别外侧副韧带（LCL）。解剖出LCL，将移植物从其下方穿过。在外侧髁近端和后方约1至2厘米处放置一个全缝合锚钉，膝关节置于中立旋转位并屈曲约60°。将移植物穿过缝线环，使用带针缝线在顶部再打一个结。然后将IT束进行侧对侧修复。根据手术顺序，以标准方式缝合剩余的皮下组织和皮肤。
在STABILITY随机对照试验中，2年的结果显示，与单纯使用腘绳肌自体移植物进行ACLR相比，增加LET后，临床失败率从40%降至25%，移植物破裂率从11%降至4%，在临床和统计学上均有显著下降。两组之间的运动恢复率相似。一项对6项研究的荟萃分析比较了初次ACLR患者中ACLR与ACLR + LET，结果显示移植物失败和术后前外侧旋转不稳定的发生率降低。
讨论/结论：LET是一种有助于降低ACLR失败风险的技术。我们的技术采用无结缝合锚钉在ACLR的情况下提供前外侧旋转稳定性。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者在提交本稿件以供发表时已包含患者的豁免声明或其他书面批准形式。
