The primary goal of an anterior cruciate ligament (ACL) reconstruction is to restore the knee’s stability and function, allowing patients to return to their normal activities and sports. However, a significant challenge arises when the initial surgery fails, requiring a revision procedure. These revision surgeries are often more complex and carry a higher risk of complications. A key factor in many ACL failures is persistent rotational instability, known as a “pivot shift,” which the isolated ACL graft alone may not be able to control.
A recent systematic review offers valuable insights into a combined surgical approach that addresses this issue head-on: revision ACL reconstruction with an additional lateral extra-articular tenodesis (LET). This report summarizes the study’s findings, highlighting how this combined procedure can lead to favorable mid-term outcomes with low rates of complications and re-injury.
Understanding the Role of Lateral Extra-Articular Tenodesis
The lateral extra-articular tenodesis is a surgical procedure that involves reinforcing the anterolateral structures of the knee, which are essential for controlling the rotational stability of the joint. By using a strip of the patient’s own iliotibial band—a thick band of tissue on the outside of the thigh—surgeons can create a new restraint that works in concert with the intra-articular ACL graft. This extra-articular augmentation procedure is particularly indicated for patients at high risk of re-rupture, such as those who are young, have a high-grade pivot shift, or are returning to high-demand pivoting sports.
For patients undergoing revision ACL surgery, who already face compromised anatomy and biomechanics, the addition of a LET offers a crucial protective effect. It helps to share the load with the new ACL graft, preventing it from being subjected to excessive rotational forces that can lead to stretching or re-rupture.
Favorable Outcomes in Mid-Term Follow-up
The systematic review analyzed data from a total of 12 studies, encompassing 851 patients with a weighted mean follow-up of nearly five years. The findings were consistently positive, demonstrating that the combined approach successfully addressed key issues associated with revision ACL surgery. The study reported that the procedure was highly effective in restoring stability, with objective evaluations showing an impressive 80% negative pivot-shift test.
From a patient-reported perspective, the outcomes were equally promising. Clinical scores such as the Lysholm, IKDC, and KOOS, which measure pain, function, and quality of life, indicated favorable results across the included studies. The procedure also demonstrated a high rate of return to sport, with 74% of patients successfully returning to their previous athletic level. Perhaps most importantly for a revision procedure, the study highlighted a low failure rate of just 3.6% and a low complication rate of 8.0%, which are crucial metrics for long-term patient success.
Clinical Considerations and Future Research
Despite these strong mid-term results, the study’s authors emphasize a significant point: the current body of literature consists primarily of retrospective and prospective case series. While these studies provide encouraging data, there is a notable lack of high-level, randomized controlled trials. This means that while combining an LET with a revision ACL is a common and accepted practice in many clinical settings, more robust research is still needed to definitively establish its superiority and refine patient selection criteria.
The findings from this review confirm that the combined revision ACL and LET procedure is a reliable and effective option for improving knee stability and functional outcomes. It is a powerful tool in the hands of surgeons for managing the complexities of a failed ACL reconstruction, and it offers new hope for patients seeking to regain stability and return to their active lifestyles.
For a comprehensive analysis of the full data and methodology, we encourage you to read the complete research paper.
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/31324964/
- https://www.researchgate.net/publication/365560744_Lateral_Extra-articular_Tenodesis_in_Revision_Anterior_Cruciate_Ligament_Reconstruction
- https://orthosports.com.au/lateral_extra-articular_tenodesis
- https://www.mdpi.com/2077-0383/13/23/7201
- https://www.arthrex.com/knee/iliotibial-band-tenodesis
