Lateral Extra-Articular Tenodesis

The goal of lateral extra-articular augmentation or reconstruction is to eliminate residual laxity and reduce the risk of ACL graft rupture. Two common techniques include iliotibial band (ITB) tenodesis and anterolateral ligament (ALL) reconstruction. These procedures play a role in augmenting rotational stability in the ACL-reconstructed knee. Patients who see the benefits, include hyperlax patients, revision cases, pivoting athletes, and those with IKDC grade III pivot shifts.

There are several distinct advantages of using adjustable, tensionable implant technology, such as the Knotless FiberTak® anchor or FiberTag® TightRope® implant, when compared to traditional techniques using staples or interference screws:

  • Simple: Quick, easy, and reproducible techniques
  • Safe: Knotless FiberTak anchor sets just below the cortex, reducing the risk of femoral tunnel convergence of the ACL; the self-punching anchor technique is designed to reduce the risk of damaging the ACL graft as with traditional techniques that require drilling; no risk of graft laceration as described with interference-screw techniques1
  • Low profile: Techniques using additional hardware, such as staples, may lead to pain or discomfort, warranting removal; no prominent hardware is part of the Knotless FiberTak anchor or TightRope implant1
  • Preserves anatomy: No socket drilling involved in the Knotless FiberTak onlay technique
  • Titratable graft tensioning: Using these techniques, a surgeon can provisionally tension and incrementally retension the graft after checking for isometry and overconstraint

Reference

1. Muller B, Willinge GJA, Zijl JAC. Minimally invasive modified Lemaire tenodesis. Arthrosc Tech. 2020;10(1):e29- e36. doi:10.1016/j.eats.2020.09.006

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The goal of lateral extra-articular augmentation or reconstruction is to eliminate residual laxity and reduce the risk of ACL graft rupture. Two common techniques include iliotibial band (ITB) tenodesis and anterolateral ligament (ALL) reconstruction. These procedures play a role in augmenting rotational stability in the ACL-reconstructed knee. Patients who see the benefits, include hyperlax patients, revision cases, pivoting athletes, and those with IKDC grade III pivot shifts.

There are several distinct advantages of using adjustable, tensionable implant technology, such as the Knotless FiberTak® anchor or FiberTag® TightRope® implant, when compared to traditional techniques using staples or interference screws:

  • Simple: Quick, easy, and reproducible techniques
  • Safe: Knotless FiberTak anchor sets just below the cortex, reducing the risk of femoral tunnel convergence of the ACL; the self-punching anchor technique is designed to reduce the risk of damaging the ACL graft as with traditional techniques that require drilling; no risk of graft laceration as described with interference-screw techniques1
  • Low profile: Techniques using additional hardware, such as staples, may lead to pain or discomfort, warranting removal; no prominent hardware is part of the Knotless FiberTak anchor or TightRope implant1
  • Preserves anatomy: No socket drilling involved in the Knotless FiberTak onlay technique
  • Titratable graft tensioning: Using these techniques, a surgeon can provisionally tension and incrementally retension the graft after checking for isometry and overconstraint

Reference

1. Muller B, Willinge GJA, Zijl JAC. Minimally invasive modified Lemaire tenodesis. Arthrosc Tech. 2020;10(1):e29- e36. doi:10.1016/j.eats.2020.09.006

View More

Educational Resources and Products

LET Using a Double Knotless Knee FiberTak® Anchor in a FiberStaple™ Technique

Walter R. Lowe, MD
Surgical Technique Videos | 08:14 | English | 08/07/2023 | VID1-003813-en-US A

LET Using the QuadPro™ Harvester and a Double Knotless Knee FiberTak® Anchor

Peter MacDonald, MD
Surgical Technique Videos | 05:13 | English | 06/03/2024 | VID1-006085-en-US A
Iliotibial Band Tenodesis Using the FiberStaple™ Technique and Double Knotless Knee FiberTak® Anchor
Iliotibial Band Tenodesis Using the FiberStaple™ Technique and Double Knotless Knee FiberTak® Anchor
Surgical Technique Animations | 03:22 | English | 10/24/2023 | AN1-000529-en-US A
IT Band Tenodesis With the Double-Knotless Knee FiberTak® Anchor
IT Band Tenodesis With the Double-Knotless Knee FiberTak® Anchor
Surgical Technique Guides | English | 07/18/2023 | LT1-000272-en-US B
Lateral Extra-Articular Procedure Scientific Update
Lateral Extra-Articular Procedure Scientific Update
Scientific Updates | English | 09/10/2024 | LA1-00037-EN F
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(15)
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Surgical Technique Videos (4)

LET Using the QuadPro™ Harvester and a Double Knotless Knee FiberTak® Anchor
LET Using the QuadPro™ Harvester and a Double Knotless Knee FiberTak® Anchor
Peter MacDonald, MD
05:13 | English | 06/03/2024 | VID1-006085-en-US A
FiberStaple™ Lateral Extra-Articular Tenodesis (LET) Using a Double Knotless Knee FiberTak® Anchor
FiberStaple™ Lateral Extra-Articular Tenodesis (LET) Using a Double Knotless Knee FiberTak® Anchor
Aaron J. Krych, MD
08:35 | English | 01/15/2024 | VID1-005747-en-US A
LET Using a Double Knotless Knee FiberTak® Anchor in a FiberStaple™
Technique
LET Using a Double Knotless Knee FiberTak® Anchor in a FiberStaple™ Technique
Walter R. Lowe, MD
08:14 | English | 08/07/2023 | VID1-003813-en-US A
Iliotibial Band Tenodesis Using the FiberTag® TightRope® Implant
Iliotibial Band Tenodesis Using the FiberTag® TightRope® Implant
Michael G. Baraga, MD
05:15 | English | 06/24/2020 | VID1-000894-en-US A

Surgical Technique Animations (1)


Surgical Technique Guides (2)


Catalogs (1)

Knee Next Generation in Repair and Reconstruction | 2022
Knee Next Generation in Repair and Reconstruction | 2022
English | 05/18/2022 | LB1-0115-en-US AB

Miscellaneous (1)

Knee FiberTak®  Anchors
Knee FiberTak® Anchors
English | 02/08/2024 | DOC1-001277-en-US A

Orthopedia.com Video Links (1)

OTIF: Technique Update—Lateral Extra-Articular Tenodesis in the Knee
OTIF: Technique Update—Lateral Extra-Articular Tenodesis in the Knee
English | 02/21/2022 | LINK_VID1-003220-en-US A

Presentation Videos (2)

Extra-articular Tenodesis and ALL Reconstruction
Extra-articular Tenodesis and ALL Reconstruction
Asheesh Bedi, MD
11:50 | English | 06/04/2020 | VID1-000946-en-US A
Management of the Anterolateral Complex of the Knee
Management of the Anterolateral Complex of the Knee
Seth L. Sherman, MD
12:05 | English | 01/29/2020 | VID1-000592-en-US A

Scientific Updates (1)

Lateral Extra-Articular Procedure Scientific Update
Lateral Extra-Articular Procedure Scientific Update
English | 09/10/2024 | LA1-00037-EN F
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