Forsythe Brian, Gamsarian Vahram, Pan Amanda, Mirle Vikranth, Forlenza Enrico, Allahabadi Sachin
Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.
Video J Sports Med. 2023 Oct 31;3(5):26350254231205909. doi: 10.1177/26350254231205909. eCollection 2023 Sep-Oct.
Lateral extra-articular tenodesis (LET) is a reproducible and reliable technique to assist in control of rotational stability of the knee and decrease forces across an anterior cruciate ligament (ACL) graft in the setting of ACL reconstruction. Bone-tendon-bone (BTB) autograft is a common graft choice in revision ACL reconstruction. We present a technique for combining contralateral BTB autograft with LET in revision ACL reconstruction.
This technique is indicated in patients undergoing ACL reconstruction who are at increased risk of graft failure, including revision cases, high-grade rotational instability, return to pivoting/cutting sports, ligamentous laxity, young age, meniscal deficiency, and hyperextension/recurvatum.
The contralateral BTB autograft is harvested through standard fashion. We begin with the LET dissection prior to fluid infiltration in the soft tissues. A 1-cm strip of iliotibial (IT) band is harvested and whipstitched. The IT band strip is passed from anterior to posterior deep to the lateral collateral ligament (LCL). The LET socket is aimed 10° proximal and 10° anterior to limit tunnel convergence with the ACL. The LET is fixed with a tenodesis screw with the knee in neutral rotation and 30° of flexion. The ACL femoral socket is then placed, and care is taken to avoid convergence. A 10-mm tibial tunnel is drilled near the level of the posterior margin of the anterior horn of the lateral meniscus. The ACL is subsequently fixed with standard techniques.
The addition of LET to revision ACL has been shown to improve failure rate and outcomes. The use of contralateral patella tendon graft reduces morbidity on the operated leg. Notably, the position of the femoral LET tunnel is less important than the ACL tunnel position on the femur. If the LET is passed under the LCL, then the fixation point on femur becomes less relevant. The technique presented is a time-efficient way for combining tenodesis with revision ACL.
DISCUSSION/CONCLUSION: Performing a revision ACL reconstruction utilizing contralateral donor tissue with the addition of LET is a viable and reliable option for competitive athletes.
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.
外侧关节外肌腱固定术（LET）是一种可重复且可靠的技术，有助于控制膝关节的旋转稳定性，并在进行前交叉韧带（ACL）重建时减少通过ACL移植物的力。骨-肌腱-骨（BTB）自体移植物是翻修ACL重建中常用的移植物选择。我们介绍一种在翻修ACL重建中将对侧BTB自体移植物与LET相结合的技术。
该技术适用于接受ACL重建且移植物失败风险增加的患者，包括翻修病例、高度旋转不稳定、恢复旋转/急停运动、韧带松弛、年轻、半月板缺损以及膝关节过伸/反屈。
对侧BTB自体移植物通过标准方式获取。我们在软组织液体浸润之前开始进行LET解剖。切取一条1厘米宽的髂胫束（IT）带并进行锁边缝合。将IT带从前向后穿过外侧副韧带（LCL）深层。LET骨道的方向为近端10°、前方10°，以限制与ACL骨道的汇聚。在膝关节中立旋转和屈曲30°时，用一枚固定螺钉固定LET。然后放置ACL股骨骨道，并注意避免汇聚。在外侧半月板前角后缘水平附近钻一个10毫米的胫骨骨道。随后用标准技术固定ACL。
在翻修ACL中增加LET已被证明可提高失败率和改善治疗效果。使用对侧髌腱移植物可降低手术侧肢体的发病率。值得注意的是，股骨LET骨道的位置比股骨上ACL骨道的位置重要性稍低。如果LET从LCL下方穿过，那么股骨上的固定点就变得不那么重要了。所介绍的技术是一种将肌腱固定术与翻修ACL相结合的高效方法。
讨论/结论：对于竞技运动员来说，利用对侧供体组织并增加LET进行翻修ACL重建是一种可行且可靠的选择。
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，作者已包含一份豁免声明或其他书面形式。
