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Journal articles on the topic 'Lateral tenodesis'

Author: Grafiati

Published: 7 September 2024

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1

Inderhaug, Eivind, Joanna M. Stephen, Andy Williams, and Andrew A. Amis. "Effect of Anterolateral Complex Sectioning and Tenodesis on Patellar Kinematics and Patellofemoral Joint Contact Pressures." American Journal of Sports Medicine 46, no. 12 (August 20, 2018): 2922–28. http://dx.doi.org/10.1177/0363546518790248.

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Background: Anterolateral complex injuries are becoming more recognized. While these are known to affect tibiofemoral mechanics, it is not known how they affect patellofemoral joint behavior. Purpose: To determine the effect of (1) sectioning the anterolateral complex and (2) performing a MacIntosh tenodesis under various conditions on patellofemoral contact mechanics and kinematics. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees were tested in a customized rig, with the femur fixed and tibia free to move, with optical tracking to record patellar kinematics and with thin pressure sensors to record patellofemoral contact pressures at 0°, 30°, 60°, and 90° of knee flexion. The quadriceps and iliotibial tract were loaded with 205 N throughout testing. Intact and anterolateral complex–sectioned states were tested, followed by 4 randomized tenodeses applying 20- and 80-N graft tension, each with the tibia in its neutral intact alignment or left free to rotate. Statistical analyses were undertaken with repeated measures analysis of variance, Bonferroni post hoc analysis, and paired samples t tests. Results: Patellar kinematics and contact pressures were not significantly altered after sectioning of the anterolateral complex (all: P > .05). Similarly, they were not significantly different from the intact knee in tenodeses performed when fixed tibial rotation was combined with 20- or 80-N graft tension (all: P > .05). However, grafts tensioned with 20 N and 80 N while the tibia was free hanging resulted in significant increases in lateral patellar tilt ( P < .05), and significantly elevated lateral peak patellofemoral pressures ( P < .05) were observed for 80 N. Conclusion: This work did not find that an anterolateral injury altered patellofemoral mechanics or kinematics, but adding a lateral tenodesis can elevate lateral contact pressures and induce lateral patellar tilting if the tibia is pulled into external rotation by the tenodesis. Although these in vitro changes were small and might not be relevant in a fully loaded knee, controlling the position of the tibia at graft fixation is effective in avoiding overconstraint at time zero in a lateral tenodesis. Clinical Relevance: Small changes in lateral patellar tilt and patellofemoral contact pressures were found at time zero with a MacIntosh tenodesis. These changes were eliminated when the tibia was held in neutral rotation at the time of graft fixation. The risk of overconstraint after a lateral tenodesis therefore seems low and in accordance with recent published reports.

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2

Espiritu, Wesson Pious A., and Melissa Mae R. Sanchez. "How to avoid knee tunnel convergence when performing a combined anterior cruciate ligament reconstruction and lateral extraarticular tenodesis utilizing the antero medial window." International Journal of Research in Orthopaedics 9, no. 6 (October 26, 2023): 1292–97. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20233282.

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The anterolateral structures of the knee have been demonstrated to have a significant impact on reducing rotational instability and the forces applied to the anterior cruciate ligament reconstruction (ACL) graft after surgical reconstruction. Combined ACL reconstruction and lateral extraarticular tenodesis are being performed at an increasing number due to its promising outcome in properly indicated patients. However, tunnel convergence in combined ACLR and lateral extraarticular tenodesis can lead to graft damage and possible failure defeating the purpose of this very effective technique. This technical note describes how to avoid knee tunnel convergence when performing a combined ACL reconstruction with lateral extraarticular tenodesis utilizing the “Antero medial window”.

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3

Catanzariti, Alan R., and Robert W. Mendicino. "Tenodesis for Chronic Lateral Ankle Instability." Clinics in Podiatric Medicine and Surgery 18, no. 3 (July 2001): 429–42. http://dx.doi.org/10.1016/s0891-8422(23)01203-x.

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4

Paraschiv, Radu, George Dinache, Marinel Drignei, Eric Jovenet, Dumitru Ferechide, and Sorin Lazarescu. "Lateral Extraarticular Tenodesis in Combined ACL and ALL Reconstruction. Case presentation." Revista de Chimie 69, no. 12 (January 15, 2019): 3749–52. http://dx.doi.org/10.37358/rc.18.12.6834.

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The purpose of this paper was to evaluate the necesity of associating a lateral extraarticular tenodesis in patients that will undergo an anterior cruciate ligament reconstruction or revision and to briefly describe the surgical procedure. Multiple lateral extraarticular tenodesis techniques were described and also graft selection and fixation types are also important. In conclusion acute ACL tears with grade 3+ pivot shift can be succesfully treated by combined ACL reconstruction and LEAT association.

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5

Juliano, Paul J., Mark S. Myerson, and Bryan W. Cunningham. "Biomechanical Assessment of a New Tenodesis for Correction of Hallux Varus." Foot & Ankle International 17, no. 1 (January 1996): 17–20. http://dx.doi.org/10.1177/107110079601700104.

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Each of six below-the-knee amputation specimens were transfixed to a wooden block and mounted to a jig on an amputee testing device preloaded with 5 N applied to the proximal phalanx and displaced at a constant rate of 2 mm/min. Load displacement curves were generated for the intact joint and after sequential incisions of the lateral capsule, the adductor hallucis, and the lateral slip of the flexor hallucis brevis tendon, which caused varus dislocation of the hallux. An extensor hallucis brevis tenodesis was performed after the varus dislocation. Division of the lateral capsule, the adductor, and the flexor brevis reduced the force required to displace the hallux by 42.2%, an additional 25.2%, and a further 14.2%, respectively. Use of the extensor hallucis brevis tenodesis restored the load displacement curves to that of the normal joint. We concluded that the extensor hallucis brevis tendon may be useful as a tenodesis for reconstructing the deformity of acquired hallux varus.

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6

Castilho, Rodrigo Simões, João Murilo Brandão Magalhães, Bruno Peliz Machado Veríssimo, Carlo Perisano, Tommaso Greco, and Roberto Zambelli. "Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results." Medicina 60, no. 1 (January 5, 2024): 104. http://dx.doi.org/10.3390/medicina60010104.

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Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco’s zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.

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7

Aicale, Rocco, and Nicola Maffulli. "Chronic Lateral Ankle Instability: Topical Review." Foot & Ankle International 41, no. 12 (November 4, 2020): 1571–81. http://dx.doi.org/10.1177/1071100720962803.

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Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Failure after strict rehabilitation may be an indication for surgery. Several operative options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Anatomic repair can be performed when the quality of the damaged ligaments permits. Anatomic reconstruction with an autograft or allograft should be considered when the torn ligaments are not adequate. Ankle arthroscopy is a useful adjunct to ligamentous procedures, performed at the time of repair to identify and treat intra-articular conditions that may be associated with chronic ankle instability. Tenodesis techniques are not recommended because of their suboptimal long-term results related to the modification of ankle and hindfoot biomechanics. Level of Evidence: Level V, expert opinion.

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8

Batty, Lachlan, and Timothy Lording. "Clinical Results of Lateral Extra-Articular Tenodesis." Techniques in Orthopaedics 33, no. 4 (December 2018): 232–38. http://dx.doi.org/10.1097/bto.0000000000000309.

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9

Lubowitz, James H. "Editorial Commentary: Knee Lateral Extra-articular Tenodesis." Arthroscopy: The Journal of Arthroscopic & Related Surgery 31, no. 10 (October 2015): 2035. http://dx.doi.org/10.1016/j.arthro.2015.07.007.

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10

Castoldi, Marie, Cécile Batailler, Stanislas Gunst, Philippe Neyret, Sébastien Lustig, and Elvire Servien. "A prospective study of bone-tendon-bone ACL reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up." Orthopaedic Journal of Sports Medicine 7, no. 5_suppl3 (May 1, 2019): 2325967119S0021. http://dx.doi.org/10.1177/2325967119s00212.

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Objectives Anterior cruciate ligament (ACL) arthroscopic reconstruction with a patellar tendon graft (BTB) is a well-known and reliable surgical option for control of anterior laxity, at short and middle term. Most of those patients are young and practice sports, often at high level. Few studies have evaluated the long term effects of ACL reconstruction, and more specifically lateral tenodesis, on knee function. It has been shown that chronic anterior instability, when left untreated, evolves towards femorotibial osteoarthritis in the 10 to 20 years after ACL rupture. This study aims to compare long-term survival and femorotibial arthritis between ACL reconstruction with and without lateral tenodesis. Methods 121 consecutive knees (120 patients) presenting with an ACL rupture between 1998 and 1999 were included in this prospective randomized monocentric study. For the 61 knees in group BTB, an isolated patellar tendon plasty with outside-in technique was performed. For 60 knees in group BTB-T, the intra-articular plasty was associated with a lateral tenodesis with gracilis tendon. Patients were reviewed at 1 year, 6 years and 19 years post-operatively. Results 80 patients were contacted with a minimum follow-up of 19 years. 43 patients had a clinical examination and the 37 other patients were evaluated through a telephone questionnaire. We had standard X-rays for 45 patients and laximetry (TELOS™) for 42 patients. 41 patients (34%) were lost to follow-up. 16 knees (20%) had experienced a graft failure, 5 of which had had an iterative ACL plasty. The difference between group BTB (27.5%) and group BTB-T (13.2%) concerning graft failure was not statistically significant (p = 0.38). 32 patients (71%) had femorotibial osteoarthritis (IKDC grade C or D). There was no difference between groups BTB and BTB-T concerning medial femorotibial osteoarthritis. Lateral femorotibial osteoarthritis was significantly increased in groupe BTB-T (59%) compared to group BTB (21%) and to the contralateral knee (5%). 36 patients (45%) had had a lateral or medial meniscectomy. Mean subjective IKDC score was 81.8/100, comparable between groups BTB and BTB-T. 67% still practiced pivot sports. Conclusion At 19 years follow-up after patellar tendon ACL plasty, lateral tenodesis did not significantly improve graft survival in our study. Lateral femorotibial osteoarthritis was significantly increased in patients with a lateral tenodesis. However, a follow-up bias may be that lesions of the lateral meniscus were more frequent in BTB-T patients for whom we obtained X-rays. Functional scores were stable at over 80/100 and two thirds of patients still practiced pivot sports. ACL graft survival was 80% at 20 years follow-up.

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11

Sonnery-Cottet, Bertrand, Pooler Archbold, Rachad Zayni, Juliano Bortolletto, Mathieu Thaunat, Thierry Prost, Vitor B. C. Padua, and Pierre Chambat. "Prevalence of Septic Arthritis After Anterior Cruciate Ligament Reconstruction Among Professional Athletes." American Journal of Sports Medicine 39, no. 11 (August 19, 2011): 2371–76. http://dx.doi.org/10.1177/0363546511417567.

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Background: Septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction is a rare complication. Its prevalence and characteristics have never been reported among professional athletes. Purpose: To report the prevalence and the characteristics of septic arthritis after ACL reconstruction in professional athletes and a general population of patients. Study Design: Case control study; Level of evidence, 3. Methods: A retrospective analysis of a consecutive series of 1957 patients who underwent an ACL reconstruction between 2003 and 2008 was performed; 88 patients were professional athletes. The patient demographics, the prevalence of infection, the involved organism, and the method of treatment were reviewed. Three potential risk factors for infection—level of sporting participation, indoor/outdoor sports, and the presence or not of a combined lateral tenodesis—were assessed using univariate and multivariate logistic regression analysis. Results: The prevalence of septic arthritis was 0.37% in the nonprofessional group and 5.7% in the professional athlete population. Being a professional athlete (odds ratio [OR], 16.0; 95% confidence interval [CI], 3.9-59.8; P = .0001) or having a combined lateral tenodesis (OR, 4.8; 95% CI, 1.04-18.04; P = .02) was found to be significantly correlated with septic arthritis after ACL reconstruction. A significant correlation exists between being a professional athlete and having a combined lateral tenodesis (χ2 = 16.7; P = 4 × 10−5), suggesting a potential confounding role is played by one of these variables. All the cases of infection in the professional athletes occurred in those who participated in outdoor sports, although this was not found to be statistically significant ( P = .17). Conclusion: Participation in professional sports and having a combined lateral tenodesis are risk factors for the development of infection after ACL reconstruction. We hypothesize that professional athletes may be part of a specific group of patients at higher risk of infection after ACL reconstruction.

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Kwapisz, Adam, Scott Mollison, Jerzy Cholewiński, Peter MacDonald, Marek Synder, and Katarzyna Herman. "Lateral Extra-articular Tenodesis with Iliotibial Band Strip – a Solution for Anterolateral Instability?" Ortopedia Traumatologia Rehabilitacja 21, no. 6 (December 31, 2019): 397–406. http://dx.doi.org/10.5604/01.3001.0013.7397.

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It is widely acknowledged that anterior cruciate ligament (ACL) injury is the cause of anterolateral instability, but in some cases not only the ACL ruptures, but also anterolateral structures (ALS), including the anterolateral ligament. Their insufficiency may be the cause of residual instability after ACL reconstruction, which significantly increases the risk of graft rupture. In the past, anterolateral instability caused by ACL injury was treated with extra-articular reconstructions, including lateral extra-articular tenodesis. Nowadays those techniques are used simultaneously in cases of complex anterolateral and rotational instability. This article briefly describes historical methods of lateral tenodesis and presents step-by-step two techniques used in our departments involving two alternative graft femoral fixation methods.

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13

Trojani, Christophe, Philippe Beaufils, Gilles Burdin, Christophe Bussière, Vincent Chassaing, Patrick Djian, Frédéric Dubrana, et al. "Revision ACL reconstruction: influence of a lateral tenodesis." Knee Surgery, Sports Traumatology, Arthroscopy 20, no. 8 (November 20, 2011): 1565–70. http://dx.doi.org/10.1007/s00167-011-1765-9.

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14

Kwapisz, Adam, Scott Mollison, Sheila McRae, and Peter MacDonald. "Lateral Extra-articular Tenodesis With Proximal Staple Fixation." Arthroscopy Techniques 8, no. 8 (August 2019): e821-e825. http://dx.doi.org/10.1016/j.eats.2019.03.020.

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Burt, David M. "Lateral Decubitus Position for Arthroscopic Suprapectoral Biceps Tenodesis." Arthroscopy Techniques 9, no. 3 (March 2020): e379-e385. http://dx.doi.org/10.1016/j.eats.2019.11.005.

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16

Cheung, C. N., and T. H. Lui. "Traumatic Hallux Varus Treated by Minimally Invasive Extensor Hallucis Brevis Tenodesis." Case Reports in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/179642.

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A case of traumatic hallux varus due to avulsion fracture of the lateral side of the base of proximal phalanx was reported. The lateral instability of the first metatarsophalangeal joint was believed to be due to the disruption of adductor hallucis function. It was successfully managed by minimally invasive extensor hallucis brevis tenodesis.

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Bechis, Marco, Federica Rosso, Davide Blonna, Roberto Rossi, and Davide Edoardo Bonasia. "Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device." Journal of Clinical Medicine 13, no. 2 (January 10, 2024): 377. http://dx.doi.org/10.3390/jcm13020377.

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Background: The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. Methods: This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. Conclusions: This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button.

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Miller, Adam G., Steven M. Raikin, and Jamal Ahmad. "Near-Anatomic Allograft Tenodesis of Chronic Lateral Ankle Instability." Foot & Ankle International 34, no. 11 (June 14, 2013): 1501–7. http://dx.doi.org/10.1177/1071100713494377.

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19

Getgood, Alan, and Gilbert Moatshe. "Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction." Sports Medicine and Arthroscopy Review 28, no. 2 (June 2020): 71–78. http://dx.doi.org/10.1097/jsa.0000000000000278.

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20

Dulas, Matthew, Amrit V. Vinod, and Aravind Athiviraham. "Lateral Extra-Articular Tenodesis via an All-Suture Anchor." Video Journal of Sports Medicine 3, no. 2 (March 2023): 263502542311552. http://dx.doi.org/10.1177/26350254231155234.

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Background: In young patients, anterior cruciate ligament (ACL) reconstruction often results in graft failure. This may be due, in part, to concomitant injury to anterolateral complex (ALC) of the knee leading to rotatory laxity. The modified Lemaire lateral extra-articular tenodesis (LET) technique is intended to address the anterolateral rotatory instability due to injury to the ALC and to protect the ACL graft and meniscus. Indications: The International Anterolateral Complex Consensus Group Meeting identified 4 appropriate indications for the modified Lemaire LET procedure: revision ACL, high-grade pivot shift, generalized ligamentous laxity/genu recurvatum, and young patients returning to pivoting activities. Technique Description: The technique consists of harvesting an 8-cm long by 1-cm wide graft from the iliotibial band. The graft is released proximally and remains attached distally to Gerdy’s tubercle. The graft is then passed deep to the lateral collateral ligament (LCL) from distal to proximal. The graft is then affixed to a point proximal and posterior to the lateral femoral epicondyle with an all-suture button. The graft is then tensioned with knee at 30° of flexion and neutral rotation, and then secured in place. Results: With the modified Lemaire LET, there was previously concern for overconstraint and lateral compartment degeneration. However, recent studies have shown that there is no increased risk for these complications with the LET procedure. The STABILITY trial found that the addition of LET to ACL reconstruction significantly reduces re-rupture and residual laxity when compared with ACL reconstruction alone. Moreover, the addition of LET to ACL reconstruction can restore native knee kinematics. Conclusion: The addition of the modified Lemaire LET technique to traditional ACL reconstruction is a safe and effective adjunct that reduces the occurrence of graft rupture, addresses residual rotational laxity, and can restore native knee kinematics in appropriately indicated patient populations. Patient Consent Disclosure Statement: 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.

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Dave, Lee Yee Han. "Adding a Lateral Extraarticular tenodesis to ACL Reconstruction in 2022." Orthopaedic Journal of Sports Medicine 11, no. 2_suppl (January 1, 2023): 2325967121S0085. http://dx.doi.org/10.1177/2325967121s00857.

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Lateral extra-articular tenodesis (LET) is a procedure used to control anterolateral rotatory laxity. It was first described to treat the ACL deficient knee prior to advent of intra-articular reconstruction. The aim was adding a lateral soft tissue restraint away from the central pivot of the knee to improve rotational control. The recent evidence from the STABILITY RCT has shown that the addition of LET to hamstring autograft ACLR in young patients (14-25 years ) results in clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years postoperatively. This has subsequently been verified by various authors that adding a lateral soft tissue restraint to an intraarticular ACL reconstruction reduced both primary and revision ACL graft failures. The current indication for adding an LET to ACL surgery are : in high grade knee laxity in clinic detected on physical examination, patients with joint laxity, chronic ACL injuries, athletes returning to pivot sports after surgery and in revision ACL cases.

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Lord, Breck R., Brian M. Devitt, Hadi El Daou, Joanna M. Stephen, Andy Williams, Julian A. Feller, and Andrew A. Amis. "Should the Iliotibial Band Defect be Closed After Lateral Tenodesis?" Arthroscopy: The Journal of Arthroscopic & Related Surgery 33, no. 10 (October 2017): e121-e122. http://dx.doi.org/10.1016/j.arthro.2017.08.141.

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23

Bernholt, David L., Mitchell I. Kennedy, Matthew D. Crawford, Nicholas N. DePhillipo, and Robert F. LaPrade. "Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis." Arthroscopy Techniques 8, no. 8 (August 2019): e855-e859. http://dx.doi.org/10.1016/j.eats.2019.03.027.

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Alm, Lena, Karl-Heinz Frosch, and Ralph Akoto. "Extra articular lateral tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior instability." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0030. http://dx.doi.org/10.1177/2325967120s00306.

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Aims and Objectives: While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. Failure rates of 14 to 33% have been reported for revision ACLR. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure. Materials and Methods: Between 2013 and 2016, 150 patients were operated with revision ACLR (revision surgery after primary ACL reconstruction). Out of these patients, 73 patients preoperative had a high-grade anterior instability and were included in the retrospective study. High-grade knee anterior instability was defined as high-grade pivot-shift and/or side- to- side difference of more than 5mm in Rolimeter®-testing. An additional extra articular tenodesis was performed in 59 patients during revision ACLR. Patients were clinically examined with a minimum of 2 years after revision surgery (mean 35±6 months) and identified as “failed revision ACLR” and “stable revision ACLR”. Results: Failure of the revision ACLR occurred in 8.2% (n=6) of the cases. Extra articular lateral tenodesis leads to significant lower failure rates in patients with high-grade anterior instability in comparison to patients without further peripheral stabilization (5% vs. 21%, p=0.045). Also, higher postoperative functional scores were shown in the group of additional extra articular lateral tenodesis (Lysholm 89.5±17 vs. 69.5±12, p=0.041; Tegner 6.6±1.4 vs. 4.5±1.4, p=0.009; Cincinnati Rating Scale 91.2±14 vs. 68.5±17, p=0.006). Failure was associated with male sex (n=6 male failures, p=0.017) and obesity (n=4 obese failures with a BMI >30 kg/m2, p<0.001). Conclusion: Additional extra articular tenodesis in patients with revision ACL instability and accompanying high-grade anterior instability significantly reduces the risk of failure of revision ACLR. General risk factors of failure of the revision ACLR are obesity and male sex.

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McCahon, Joseph A. S., Mohamed F. Albana, Patrick F. Szukics, and Sean McMillan. "All Arthroscopic Suprapectoral Biceps Tenodesis." Video Journal of Sports Medicine 2, no. 6 (November 2022): 263502542211361. http://dx.doi.org/10.1177/26350254221136153.

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Background: Biceps tendinopathy can have significant clinical manifestations in active patients. Failure to achieve resolution of symptoms through nonsurgical modalities oftentimes results in surgical intervention. The 2 most common surgical treatment options for tendinopathy of the long head of the biceps tendon (LHBT) are tenotomy and tenodesis. Both modalities have shown efficacy within the literature; however, tenodesis of the LHBT has many advantages to tenotomy. Indications: Subgroove tenodesis eliminates the potential pain generation within the bicipital groove. Despite recent proof of clinical equivalence in open versus arthroscopic tenodesis, there has been increasing interest in all-arthroscopic biceps tenodesis techniques in hopes of minimizing surgical exposure, decreasing the rate of potential neurovascular compromise, and decreasing the time to recovery. Technique: We present an all-arthroscopic technique for a subgroove biceps tenodesis using a unicortical tensionable button. The proximal biceps anchor is held in place at its insertion site with a spinal needle to prevent retraction. The lateral portal is redirected into the subdeltoid space. A novel suprapectoral biceps portal, called the Willingboro portal, is placed percutaneously 2 cm above the pectoralis tendon. Onlay fixation of the LHBT is performed proximal to the pectoralis major muscle insertion using a unicortical button. Postoperative protocol is similar to other fixation constructs. Results: Numerous arthroscopic biceps tenodesis techniques have been described with good success; however, an all-arthroscopic suprapectoral tenodesis is attractive to many reasons. The unicortical button construct shows similar load to failure strength as the bicortical button construct, both of which are greater than all other constructs described in the literature. Discussion/Conclusion: Arthroscopic subgroove biceps tenodesis using a unicortical button technique is a viable option that avoids the complications associated with an open axillary incision as well as persistent groove pain. Anchoring the biceps tendon prior to tenotomy allows for preservation of tendon length, limiting the complications associated with tendon retraction with anticipated improvement in patient-reported outcomes. The unicortical button is known to have a similar strength profile as the bicortical button technique, which is greater than other techniques described in the literature. Future studies should be aimed at assessing long-term patient-reported outcomes. Patient Consent Disclosure Statement: 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.

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Danna, Natalie, James Rizkalla, Ermias Abebe, and James Brodsky. "Patient Reported Outcomes of Tenodesis to Reconstruct Peroneal Tendon Tears." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0019. http://dx.doi.org/10.1177/2473011418s00199.

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Category: Ankle Introduction/Purpose: Peroneal tendon tears are a common cause of lateral ankle pain. When the tear involves more than 50% of the tendon’s cross-sectional area, the treatment algorithm recommends tenodesis of the torn peroneal tendon to the intact peroneal tendon. Previous assessments in the literature of functional outcomes after peroneal tenodesis have widely used the American Orthopedic Foot and Ankle Score (AOFAS) survey as a measurement tool. However, this score was not designed for patient-reported outcomes and its validity and reliability have been questioned. The Medical Outcomes Shortform-36 (SF-36) and PROMIS are tools that have been extensively studied and validated. We sought to assess patient outcomes after peroneal tenodesis using validated tools: SF-36, PROMIS and AOS Disability scores. Methods: Prospective data was collected on patients undergoing peroneal tenodesis for peroneal tendon tears, and who follow up of at least one year. Patients who underwent concomitant procedures (hindfoot fusion, total ankle arthroplasty) were excluded from the study. Baseline patient-reported outcomes (PRO) scores were obtained preoperatively and compared to scores obtained at one year postoperatively. Results: We identified seventeen patients who underwent peroneal tenodesis for peroneal tendon tears. Average age was 62.1 years. SF-36 Physical Function scores increased from an average of 42.0 preop to 60.0 postop (p = 0.0095). PROMIS scores increased from 40.3 to 42.7 (p = 0.3049). There was no statistically significant improvement in postoperative SF-36 Pain scores (p = 0.3216). AOS Disability Scores dropped from 49.6 preop to 38.2 postop (p = 0.3178). AOS Pain scores decreased from 40.7 to 27.0 (p = 0.1779). Total AOS score decreased from 45.1 to 32.6 (p = 0.2204). Conclusion: The SF-36 Physical Function score, which is a validated outcome measure, showed statistically significant improvement postoperatively. Some of the other PROs for peroneal tenodesis failed to show statistically significant improvements, and this is most likely due to low numbers, rendering the cohort somewhat under-powered. Though the data is preliminary, the non-significant scores trended toward improvement. Despite the preliminary nature of this study, satisfactory outcomes of peroneal tenodesis using validated patient-reported outcome scores are demonstrated for the first time. Further study is underway to enlarge the scope of this investigation.

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Karsen, Phillip, Joseph Brinkman, Jonathan Day, Daniel McGurren, and Karan Patel. "Painful Unilateral Knee Snapping after Hyperextension Injury and Meniscus Tear." Surgery Journal 09, no. 04 (October 2023): e118-e122. http://dx.doi.org/10.1055/s-0043-1777329.

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AbstractThis case involves a healthy male with painful lateral knee pain and snapping after a hyperextension injury. Initially, this was felt to be from a displaced lateral meniscus tear; however, he failed to improve after meniscal debridement. Further workup with an ultrasound and magnetic resonance imaging identified an aberrant biceps femoris anatomy. He was taken to the operating room and the aberrant slip was identified. A tenodesis of the aberrant slip to the biceps femoris was completed. This resolved the patient's pain and snapping, and he was able to return to all activities.

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Richards, David P., Stephen S. Burkhart, and Ian KY Lo. "Arthroscopic biceps tenodesis with interference screw fixation: The lateral decubitus position." Operative Techniques in Sports Medicine 11, no. 1 (January 2003): 15–23. http://dx.doi.org/10.1053/otsm.2003.35893.

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Lord, B. R., B. M. Devitt, H. EL-Daou, J. M. Stephen, A. Williams, J. A. Feller, and A. A. Amis. "0129 - SHOULD THE ILIOTIBIAL BAND DEFECT BE CLOSED AFTER LATERAL TENODESIS?" Knee 24, no. 6 (December 2017): X. http://dx.doi.org/10.1016/j.knee.2017.08.032.

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Srinivasan, V. Balaji, and E. M. Downes. "Split peroneus longus tenodesis for chronic lateral ligamentous instability of ankle." Injury 27, no. 7 (September 1996): 467–69. http://dx.doi.org/10.1016/0020-1383(96)00069-1.

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Wilson, Thomas C., Richard C. Wilson, and Kaloian G. Ouzounov. "The Symptomatic Os Vesalianum as an Uncommon Cause of Lateral Foot Pain." Journal of the American Podiatric Medical Association 101, no. 4 (July 1, 2011): 356–59. http://dx.doi.org/10.7547/1010356.

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The os vesalianum is an uncommon pedal accessory bone located lateral to the fifth metatarsal base. It may occasionally become symptomatic and require surgical excision, as in the case reported here in a 24-year-old woman. Simple excision of the ossicle, while effective in the present case, can be complicated by the attachment of fibers of the peroneus brevis tendon into the ossicle, thus requiring careful tenorraphy and sometimes tenodesis. (J Am Podiatr Med Assoc 101(4): 356–359, 2011)

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Paús, Vicente, Ariel Graieb, and Federico Torrengo. "Lemaire extraarticular plasty in anterolateral knee instability." Orthopaedic Journal of Sports Medicine 5, no. 1_suppl (January 1, 2017): 2325967117S0000. http://dx.doi.org/10.1177/2325967117s00002.

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Anterolateral instability of the knee results from injury to the lateral capsular complex and the anterior cruciate ligament (ACL), and it should not be considered an isolated injury. Over the past years these structures have received renewed interest. The anterolateral ligament (ALL) recently described extends from the lateral side of the lateral femoral condyle to the antero-lateral edge of the tibia, and it is supposed to play a major role in anterolateral stability. ACL extra-articular tenodesis, initially developed as a single procedure, is now complementary to intra-articular plasty. Our indications are: pure rotational instability, symptomatic instability in non-athletes, and revision surgery. Lemaire-type plasty and post-opeartive care are described in detail. We suggest thorough patient history and clinical examination prior to surgical decision. Lemaire-type plasty effectively controls anterolateral instability.

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Shimakawa, Tomoyuki, Timothy A. Burkhart, Cynthia E. Dunning, Ryan M. Degen, and Alan M. Getgood. "Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy." Orthopaedic Journal of Sports Medicine 7, no. 6 (June 1, 2019): 232596711985465. http://dx.doi.org/10.1177/2325967119854657.

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Background: Modified Lemaire lateral extra-articular tenodesis (LET) has been proposed as a method of addressing persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR). However, concerns remain regarding the potential for increasing lateral compartment contact pressures. Purpose: To investigate changes in tibiofemoral joint contact pressures after isolated ACLR and combined ACLR plus LET with varying states of a lateral meniscal injury. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knee specimens (mean age, 60.0 ± 3.4 years) were utilized for this study, with specimens potted and loaded on a materials testing machine. A pressure sensor was inserted into the lateral compartment of the tibiofemoral joint, and specimens were loaded at 0°, 30°, 60°, and 90° of flexion in the following states: (1) baseline (ACL- and anterolateral ligament–deficient), (2) ACLR, (3) ACLR with LET, (4) partial meniscectomy (removal of 50% of the posterior third of the lateral meniscus), (5) subtotal meniscectomy (removal of 100% of the posterior third of the lateral meniscus), and (6) LET release (LETR). Mean contact pressure, peak pressure, and center of pressure were analyzed using 1-way repeated-measures analysis of variance. Results: Across all flexion angles, there was no statistically significant increase in the mean contact pressure or peak pressure after ACLR plus LET with and without lateral meniscectomy compared with isolated ACLR. There was a significant reduction in the mean contact pressure, from baseline, after subtotal meniscectomy (69.72% ± 19.27% baseline; P = .04) and LETR (65.81% ± 13.40% baseline; P = .003) at 0° and after the addition of LET to ACLR at 30° (61.20% ± 23.08% baseline; P = .031). The center of pressure was observed to be more anterior after partial (0°, 30°) and subtotal (0°, 60°) meniscectomy and LETR (0°, 30°, 60°). Conclusion: Under the loading conditions of this study, LET did not significantly alter lateral compartment contact pressures when performed in conjunction with ACLR in the setting of an intact or posterior horn–deficient lateral meniscus. Clinical Relevance: This study should provide surgeons with the confidence that it is safe to perform LET in this manner in conjunction with ACLR without altering lateral compartment pressures, regardless of the status of the lateral meniscus.

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Marom, Niv, Hamidreza Jahandar, Thomas J. Fraychineaud, Zaid A. Zayyad, Hervé Ouanezar, Daniel Hurwit, Andrew Zhu, et al. "Lateral Extra-articular Tenodesis Alters Lateral Compartment Contact Mechanics under Simulated Pivoting Maneuvers: An In Vitro Study." American Journal of Sports Medicine 49, no. 11 (July 27, 2021): 2898–907. http://dx.doi.org/10.1177/03635465211028255.

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Background: There is concern that utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) may disturb lateral compartment contact mechanics and contribute to joint degeneration. Hypothesis: ACLR augmented with LET will alter lateral compartment contact mechanics in response to simulated pivoting maneuvers. Study Design: Controlled laboratory study. Methods: Loads simulating a pivot shift were applied to 7 cadaveric knees (4 male; mean age, 39 ± 12 years; range, 28-54 years) using a robotic manipulator. Each knee was tested with the ACL intact, sectioned, reconstructed (via patellar tendon autograft), and, finally, after augmenting ACLR with LET (using a modified Lemaire technique) in the presence of a sectioned anterolateral ligament and Kaplan fibers. Lateral compartment contact mechanics were measured using a contact stress transducer. Outcome measures were anteroposterior location of the center of contact stress (CCS), contact force from anterior to posterior, and peak and mean contact stress. Results: On average, augmenting ACLR with LET shifted the lateral compartment CCS anteriorly compared with the intact knee and compared with ACLR in isolation by a maximum of 5.4 ± 2.3 mm ( P < .001) and 6.0 ± 2.6 mm ( P < .001), respectively. ACLR augmented with LET also increased contact force anteriorly on the lateral tibial plateau compared with the intact knee and compared with isolated ACLR by a maximum of 12 ± 6 N ( P = .001) and 17 ± 10 N ( P = .002), respectively. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress by 0.7 ± 0.5 MPa ( P = .005) and by 0.17 ± 0.12 ( P = .006), respectively, at 15° of flexion. Conclusion: Under simulated pivoting loads, adding LET to ACLR anteriorized the CCS on the lateral tibial plateau, thereby increasing contact force anteriorly. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress at 15° of flexion. Clinical Relevance: The clinical and biological effect of increased anterior loading of the lateral compartment after LET merits further investigation. The ability of LET to anteriorize contact stress on the lateral compartment may be useful in knees with passive anterior subluxation of the lateral tibia.

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Ahsan, Zahab, Ho Bin Kim, Niv Marom, Hamidreza Jahandar, Thomas Fraychineaud, Zaid Zayyad, Thomas Wickiewicz, et al. "Poster 231: Lateral Extra-articular Tenodesis Provides Supraphysiological Restraint to Internal Tibial Rotation: In vitro Biomechanical Assessment." Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0079. http://dx.doi.org/10.1177/2325967121s00792.

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Objectives: Lateral extra-articular tenodesis (LET) reduces ACL graft failure rates two years after surgery when performed as an adjunct to ACL reconstruction (ACLR). Interestingly, previous biomechanical studies have shown that LET may reduce tibial rotation beyond that of the intact knee, while others found no such kinematic overconstraint. Parameters of ligament engagement have proven useful in characterizing the biomechanical function of the ACL and the anterolateral ligament; however, they have not been used to describe the biomechanics of LET. In this study, we compared engagement parameters (engagement point, in situ stiffness, and tissue force at peak applied load) of an LET-reconstructed knee compared to the native lateral tissues in response to an internal rotation torque at 0°, 30°, 60°, and 90° of knee flexion. Methods: Seven cadaveric knees (mean age: 39 ± 12; range: 28-54; 4 male) were mounted to a robotic manipulator. The robot applied an internal rotation torque of 5 Nm while monitoring the resulting internal tibial rotation (ITR) (in degrees). Each knee was tested following a bone-patellar tendon-bone ACL reconstruction with intact lateral tissues (consisting of the anterolateral ligament and Kaplan fibers) and after sectioning these tissues and performing LET (modified Lemaire technique). Resultant forces carried by the native lateral tissues and the LET were determined via superposition. The parameters of engagement were determined for both the native lateral tissues and the LET and compared via two-way repeated measures ANOVA (p < 0.05). Results: During an internal rotation test at full extension (0° of flexion), both the LET-reconstructed and native lateral tissues did not engage. At 30°, 60°, and 90° knee flexion, the native lateral tissues exhibited more in situ slack than the LET-reconstructed lateral tissues. Specifically, the native lateral tissues had 8° (p < 0.001), 13° (p < 0.001), and 14° (p < 0.001) more in situ slack than the LET-reconstructed lateral tissues at 30°, 60°, and 90° knee flexion, respectively. At 30° of flexion, the LET-reconstructed lateral tissues were 9° (p < 0.001) and 10° (p < 0.001) more slack than at 60° and 90° knee flexion. Across all three tested knee flexion angles (30°, 60°, and 90°), the LET-reconstructed lateral tissues had greater in situ stiffness than the native lateral tissues. The LET carried greater force at the peak applied internal rotation torque by 29 N at 30° of flexion (p = 0.006), but no statistical differences were identified at the other flexion angles. Conclusions: LET creates a supraphysiologic restraint to the native lateral tissues by engaging with less internal tibial rotation than the native lateral tissue at all flexion angles tested but full extension. The LET also carried greater force at the peak applied load and had a greater in situ stiffness at 30° of flexion than the native lateral tissues. On the whole, LET is a supraphysiological restraint to internal tibial rotation at 30° of flexion. The engagement point of LET may be modified surgically by altering the flexion angle, degree of tibial rotation at which the tenodesis is fixed, and/or the tension applied. Thus, discrepancies between previous biomechanical studies may arise from variations in one or more of these modifiable surgical parameters. [Figure: see text]

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Floyd, Edward R., Gregory B. Carlson, and Robert F. LaPrade. "Arthroscopic-Assisted Lateral Meniscal Allograft Transplantation With Open Ligamentous Extra-Articular Tenodesis." Arthroscopy Techniques 10, no. 3 (March 2021): e903-e908. http://dx.doi.org/10.1016/j.eats.2020.11.011.

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Jesani, Satyen, and Alan Getgood. "Modified Lemaire Lateral Extra-Articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction." JBJS Essential Surgical Techniques 9, no. 4 (2019): e41. http://dx.doi.org/10.2106/jbjs.st.19.00017.

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Krips, R., S. Brandsson, C. Swensson, C. N. van Dijk, and J. Karlsson. "Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle." Journal of Bone and Joint Surgery. British volume 84-B, no. 2 (March 2002): 232–36. http://dx.doi.org/10.1302/0301-620x.84b2.0840232.

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Cavaignac, Etienne, Timothée Mesnier, Vincent Marot, Andrea Fernandez, Marie Faruch, Emilie Berard, and Bertrand Sonnery-Cottet. "Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation." Orthopaedic Journal of Sports Medicine 8, no. 11 (November 1, 2020): 232596712096009. http://dx.doi.org/10.1177/2325967120960097.

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Background: It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known. Purpose: To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints. Results: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group ( P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group ( P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group ( P = .0379). No statistically significant difference was seen between groups in terms of graft healing ( P = .1663). The Lysholm score was statistically higher in the ST4 + LET group ( P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score ( P = .2683) or Tegner score ( P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9. Conclusion: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.

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Jaecker, Vera, Jan-Hendrik Naendrup, Thomas R. Pfeiffer, Bertil Bouillon, and Sven Shafizadeh. "Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures." American Journal of Sports Medicine 47, no. 11 (August 5, 2019): 2572–76. http://dx.doi.org/10.1177/0363546519864580.

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Background: Lateral extra-articular tenodesis (LET) is being increasingly performed as an additional procedure in both primary and revision anterior cruciate ligament reconstruction in patients with excessive anterolateral rotatory instability. Consistent guidelines for femoral tunnel placement would aid in intraoperative reproducible graft placement and postoperative evaluation of LET procedures. Purpose: To determine radiographic landmarks of a recently described isometric femoral attachment area in LET procedures with reference to consistent radiographic reference lines. Study Design: Descriptive laboratory study. Methods: Ten fresh-frozen cadaveric knees were dissected. The footprints of the lateral femoral epicondyle (LFE) apex and the deep aspects of the iliotibial tract, with its Kaplan fiber attachments (KFAs) on the distal femur, were marked with a 2.5-mm steel ball. True lateral radiographic images were taken. Mean absolute LFE and KFA distances were measured from the posterior cortex line (anterior-posterior direction) and from the perpendicular line intersecting the contact of the posterior femoral condyle (proximal-distal direction), respectively. Furthermore, positions were measured relative to the femur width. Finally, radiographic descriptions of an isometric femoral attachment area were developed. Results: The mean LFE and KFA positions were found to be 4 ± 4 mm posterior and 4 ± 3 mm anterior to the posterior cortex line, and 6 ± 4 mm distal and 20 ± 5 mm proximal to the perpendicular line intersecting the posterior femoral condyle, respectively. The mean LFE and KFA locations, relative to the femur width, were found at –12% and 11% (anterior-posterior) and –17% and 59% (proximal-distal), respectively. Femoral tunnel placement on or posterior to the femoral cortex line and proximal to the posterior femoral condyle within a 10-mm distance ensures that the tunnel remains safely located in the isometric zone. Conclusion: Radiographic landmarks for an isometric femoral tunnel placement in LET procedures were described. Clinical Relevance: These findings may help to intraoperatively guide surgeons for an accurate, reproducible femoral tunnel placement and to reduce the potential risk of tunnel misplacement, as well as to aid in the postoperative evaluation of LET procedures in patients with residual complaints.

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Yaseen, Zaneb, Megan Cortazzo, Monica Bolland, and Albert Lin. "Lateral antebrachial cutaneous nerve compression after subpectoral biceps tenodesis: a case report." Journal of Shoulder and Elbow Surgery 24, no. 7 (July 2015): e195-e199. http://dx.doi.org/10.1016/j.jse.2015.03.022.

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Levy, Jonathan C. "Simultaneous Rotator Cuff Repair and Arthroscopic Biceps Tenodesis Using Lateral Row Anchor." Arthroscopy Techniques 1, no. 1 (September 2012): e1-e4. http://dx.doi.org/10.1016/j.eats.2011.12.003.

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Lagae, Koen C., Joris Robberecht, Kiron K. Athwal, Peter C. M. Verdonk, and Andrew A. Amis. "ACL reconstruction combined with lateral monoloop tenodesis can restore intact knee laxity." Knee Surgery, Sports Traumatology, Arthroscopy 28, no. 4 (January 25, 2020): 1159–68. http://dx.doi.org/10.1007/s00167-019-05839-y.

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Arner, Justin W., Justin W. Arner, João V. Novaretti, Calvin K. Chan, Sene Polamalu, Christopher D. Harner, Richard E. Debski, and Bryson P. Lesniak. "Knee Lateral Extra-articular Tenodesis Decreases In-situ Force in the ACL." Arthroscopy: The Journal of Arthroscopic & Related Surgery 35, no. 12 (December 2019): e4. http://dx.doi.org/10.1016/j.arthro.2019.11.016.

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Williams, Andy. "Editorial Commentary: Lateral Extra-Articular Tenodesis Reduces Anterior Cruciate Ligament Graft Rerupture Rates: Proper Anterior Cruciate Ligament and Lateral Extra-Articular Tenodesis Technique Is Vital to Prevent Complications." Arthroscopy: The Journal of Arthroscopic & Related Surgery 38, no. 3 (March 2022): 870–72. http://dx.doi.org/10.1016/j.arthro.2021.11.029.

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Ihsan Kilic, Ali, Onur Hapa, Ramadan Ozmanevra, Nihat Demirhan Demirkiran, and Onur Gursan. "Biceps tenodesis combined with rotator cuff repair increases functional status and elbow strength." Journal of Orthopaedic Surgery 29, no. 3 (September 2021): 230949902110569. http://dx.doi.org/10.1177/23094990211056978.

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Purpose The aim of the present study was to prospectively evaluate the elbow flexion and supination strengths and the functional outcomes of patients following arthroscopic rotator cuff repair combined with simultaneous biceps tenodesis. Methods 19 patients who underwent arthroscopic rotator cuff repair and biceps tenodesis with at least 24 months of follow-up were included. Patients were evaluated using a visual analog scale (VAS) for bicipital groove pain, American Shoulder and Elbow Surgeons (ASES), and constant scores (CS), biceps apex distance (BAD), elbow flexion, and supination strengths. Results The VAS for biceps groove measurement averages in the postoperative 6th, 12th, and 24th months was lower in comparison to preoperative data and was considered to be statistically significant ( p < .05). The constant score, an average of all postoperative measurements and scores, was found to be higher than preoperative values and was considered to be statistically significant ( p < .01). There was a significant difference in the operated and non-operated forearm supination and elbow flexion muscle strength measurements at the postoperative 3- and 6-month follow-ups ( p < .01). Conclusion Arthroscopic biceps tenodesis into the anchors of the lateral row in combination with rotator cuff repair provides an increase in the strength of elbow flexion and forearm supination, while decreasing pain. Level of Evidence Level IV

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Akmese, Ramazan, Sancar Alp Ovali, Mehmet Mesut Celebi, Batu Malatyali, and Hakan Kocaoglu. "A Surgical Algorithm According to Pivot-Shift Grade in Patients With ACL Injury: A Prospective Clinical and Radiological Evaluation." Orthopaedic Journal of Sports Medicine 9, no. 8 (August 1, 2021): 232596712110254. http://dx.doi.org/10.1177/23259671211025494.

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Background: Some patients have a positive pivot-shift finding and rotational instability after anterior cruciate ligament (ACL) reconstruction (ACLR). Three major pathologies known to affect the pivot-shift examination include ACL tear, anterolateral ligament injury, and loss of posterior lateral meniscus root function. Purpose: To describe a surgical algorithm determining indications for lateral extra-articular tenodesis (LET) based on intraoperative pivot-shift examination to prevent postoperative pivot shift and rotational instability and to evaluate the 2-year clinical and functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: The study included 47 consecutive patients (39 men and 8 women) who underwent operative treatment for ACL injury between 2016 and 2017. Pivot-shift examination was performed under anesthesia, and the pivot shift was graded as grade 1 (glide), grade 2 (clunk), or grade 3 (gross). According to the surgical algorithm, single-bundle ACLR was performed in patients with grade 1 pivot shift. In patients with grade 2 with loss of posterior lateral meniscus root function, concurrent lateral meniscal repair was performed, and in patients with grade 2 with an intact lateral meniscus posterior root, concurrent extra-articular iliotibial band tenodesis was performed. Patients with grade 3 underwent ACLR, lateral meniscal repair, and LET. Clinical and radiographic evaluations were performed. Results: The mean age was 27.2 years (range, 16-56 years). In total, 26 (55.3%) patients were evaluated as having pivot-shift grade 1; 16 (34%) patients, grade 2; and 5 (10.6%) patients, grade 3. A total of 7 (14.9%) patients underwent LET in addition to ACLR. Two of these patients had pivot-shift grade 2, and LET was performed since the lateral meniscus posterior root was intact. In 14 of 16 patients with grade 2, lateral meniscus root disruption was detected, and lateral meniscal repair was performed. One patient was excluded from the further follow-up because of graft failure. At a mean postoperative follow-up of 29 months in 46 patients, the pivot-shift examination was negative in all patients. The mean Lysholm and International Knee Documentation Committee subjective scores were 95.35 ± 4.40 and 82.87 ± 9.36, respectively. Radiographic evidence of osteoarthritis was not detected. Conclusion: Only 14.9% of patients needed LET. With proper ACL, lateral meniscal, and anterolateral ligament surgery, it was possible to prevent positive pivot-shift findings postoperatively.

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Flores, Stephen, David Hartigan, Karan Patel, Justin Roberts, and Anikar Chhabra. "Novel Operation of Snapping Biceps Femoris Tendon." Journal of Knee Surgery Reports 02, no. 01 (December 2016): e11-e16. http://dx.doi.org/10.1055/s-0036-1598013.

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Snapping biceps femoris tendon (BFT) over the fibular head is an uncommon cause of lateral knee pain. This study reports a case of nontraumatic painful snapping of the BFT due to a prominent fibular head that was persistent intraoperatively after fibular head resection. We describe a novel surgical technique of release of the anterior arm of the biceps tendon followed by soft tissue tenodesis to the popliteofibular ligament, as opposed to the remaining fibular head, to prevent iatrogenic fracture.

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Marom, Niv, Herve Ouanezar, hamidreza jahandar, Zaid Zayyad, Thomas Fraychineaud, Daniel Hurwit, Carl Imhauser, Thomas Wickiewicz, Andrew Pearle, and Danyal Nawabi. "Lateral Extra-Articular Tenodesis Reduces ACL Graft Force Under Multiplanar Torques Simulationg Pivot Shit." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0035. http://dx.doi.org/10.1177/2325967120s00356.

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Objectives: Utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament reconstruction (ACLR) has increased in recent years, however, the biomechanical impact of LET, when performed with contemporary techniques, on both load sharing between the ACL graft and the LET and on knee kinematics is not completely clear. The purpose of this study was to quantify the effect of LET performed with ACLR, in the presence of a compromised anterolateral tissues, on (1) forces carried by the ACL graft and the LET and (2) knee kinematics, during simulated pivot shift. Methods: manipulator equipped with a six-axis force-torque sensor. The robot applied multiplanar torques simulating two types of pivot shift (PS) subluxing the lateral compartment at 15° and 30° of knee flexion. The following loading combinations were applied: (PS1) 8 Nm of valgus and 4 Nm of internal rotation torques; (PS2) 100 N compression force, 8 Nm valgus torque, 2 Nm internal rotation torque, and 30 N anterior force. Anteroposterior (AP) translation in the lateral compartment of the knee was recorded in the following states: ACL intact, sectioned, reconstructed and, finally, after sectioning the anterolateral ligament (ALL) and kaplan fibers and performing a LET. ACLR was performed utilizing a bone-patellar tendon-bone autograft, via medial parapatellar arthrotomy. LET was performed using a modified lemaire technique with a metal staple femoral fixation at 60° of flexion in neutral rotation. Resultant forces carried by the ACL graft and LET at the peak applied load in all tested conditions were determined utilizing the principle of superposition and serial sectioning. Results: Under both simulated pivot shift types and at both flexion angles the ACL force decreased with the addition of a LET, with the least force reduction of 39% for PS2 at 15° (p=0.01) and the most force reduction of 80% for PS1 at 30° (p<0.001). While decreasing ACL force, the LET carried at least 43% of the force carried by the ACL graft when tested without LET for PS2 at 15° and 91% of the force carried by the ACL graft at most, for PS1 at 30° (Table 1). For both combinations of multiplananr torques and at both flexion angles, the anterior tibial translation in the lateral compartment decreased for the ACLR+LET knee compared to the intact knee (5.3mm and 7.6mm decrease, for PS1 15° and 30° respectively, p<0.001; 4.4mm p=0.005 and 7.6mm p<0.001, for PS2 15° and 30°, respectively). (Figure 2). Conclusion: During a simulated pivot shift, LET shields the ACL graft from loading. This effect was greatest at 30° of flexion with an 80% drop in ACL graft force. While some shielding of load from the ACL graft can be beneficial, a more significant reduction in the load of the ACL graft may potentially be detrimental to the graft remodeling, maturation and function. The optimal load sharing pattern for improved clinical outcomes is not well understood and merit further investigation. In addition, LET also decreases anterior tibial translation in the lateral compartment to less than that of the intact knee, which represents overconstraint of the lateral compartment. These findings may support the purported “protective” effect of LET on the ACL graft and its important role in stabilizing the lateral compartment in the setting of combined ACL and anterolateral structures deficiency. The influence of overconstraint of the lateral compartment with LET warrants further biomechanical and clinical evaluation. [Table: see text][Figure: see text][Figure: see text]

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Inderhaug, Eivind, Joanna M. Stephen, Andy Williams, and Andrew A. Amis. "Biomechanical Comparison of Anterolateral Procedures Combined With Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 45, no. 2 (December 27, 2016): 347–54. http://dx.doi.org/10.1177/0363546516681555.

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Abstract:

Background: Anterolateral soft tissue structures of the knee have a role in controlling anterolateral rotational laxity, and they may be damaged at the time of anterior cruciate ligament (ACL) ruptures. Purpose: To compare the kinematic effects of anterolateral operative procedures in combination with intra-articular ACL reconstruction for combined ACL plus anterolateral–injured knees. Study Design: Controlled laboratory study. Methods: Twelve cadaveric knees were tested in a 6 degrees of freedom rig using an optical tracking system to record the kinematics through 0° to 90° of knee flexion with no load, anterior drawer, internal rotation, and combined loading. Testing was first performed in ACL-intact, ACL-deficient, and combined ACL plus anterolateral–injured (distal deep insertions of the iliotibial band and the anterolateral ligament [ALL] and capsule cut) states. Thereafter, ACL reconstruction was performed alone and in combination with the following: modified MacIntosh tenodesis, modified Lemaire tenodesis passed both superficial and deep to the lateral collateral ligament, and ALL reconstruction. Anterolateral grafts were fixed at 30° of knee flexion with both 20 and 40 N of tension. Statistical analysis used repeated-measures analyses of variance and paired t tests with Bonferroni adjustments. Results: ACL reconstruction alone failed to restore native knee kinematics in combined ACL plus anterolateral–injured knees ( P < .05 for all). All combined reconstructions with 20 N of tension, except for ALL reconstruction ( P = .002-.01), restored anterior translation. With 40 N of tension, the superficial Lemaire and MacIntosh procedures overconstrained the anterior laxity in deep flexion. Only the deep Lemaire and MacIntosh procedures—with 20 N of tension—restored rotational kinematics to the intact state ( P > .05 for all), while the ALL underconstrained and the superficial Lemaire overconstrained internal rotation. The same procedures with 40 N of tension led to similar findings. Conclusion: In a combined ACL plus anterolateral–injured knee, ACL reconstruction alone failed to restore intact knee kinematics. The addition of either the deep Lemaire or MacIntosh tenodesis tensioned with 20 N, however, restored native knee kinematics. Clinical Relevance: The current study indicates that unaddressed anterolateral injuries, in the presence of an ACL deficiency, result in abnormal knee kinematics that is not restored if only treated with intra-articular ACL reconstruction. Both the modified MacIntosh and modified deep Lemaire tenodeses (with 20 N of tension) restored native knee kinematics at time zero.

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