Lateral Extra-Articular Tenodesis with ACL Reconstruction: Redefining Rotational Knee Stability — The Auxein Approach

Overview

Lateral Extra-Articular Tenodesis (LET) has regained prominence as a crucial complement to Anterior Cruciate Ligament Reconstruction (ACLR), enhancing rotational stability and reducing the rate of graft failure. Integrating biomechanical innovation with clinical research, Auxein continues to redefine fixation strategies for optimal surgical outcomes.

Auxein Perspective: Precision in Stability

Auxein’s design philosophy merges biomechanical integrity with surgical efficiency. Our anchor systems, fixation devices, and graft management solutions ensure consistent performance and long-term joint stability. By aligning engineering innovation with clinical need, Auxein enables surgeons to restore mobility with confidence.

Biomechanics of LET + ACLR

LET enhances rotational control by resisting excessive tibial internal rotation and anterior translation. Combined with ACLR, it decreases graft strain by approximately 50% (Guenther et al., JBJS, 2017), ensuring a balanced load-sharing mechanism. Studies consistently show that the dual approach reduces pivot shift phenomena and lowers graft rupture rates.

Figure 1 Pull-out Strength Comparison (N)
Figure 2 Return-to-Sports Rate After Reconstruction

Clinical Evidence and Comparison

Study (Year)ProcedureFailure RatePivot Shift ReductionPatient Satisfaction
Rowan et al., 2019ACLR + LET↓3.8%↓45%92%
Perelli et al., 2023Isolated LETN/AModerate85%
Minguell et al., 2023Revision ACLR + LET↓5–10%Strong89%
Zanna et al., 2023ACLR + LET↓35%↓60%94%
Condello et al., 2019Allograft ACLR + LET↓40% strain↓48%90%

Advantages of LET with ACL Reconstruction

  • Superior rotational knee stability
  • Lower graft rupture and revision rates
  • Enhanced pivot shift control in athletes
  • Facilitates early and confident return to sport
  • Ideal adjunct for high-risk populations

Disadvantages and Considerations

  • Requires advanced surgical expertise
  • Potential over constraint if over-tensioned
  • Mild postoperative stiffness possible
  • Increased operation time versus isolated ACLR
Figure 3 Complication Distribution in Combined Procedure

Clinical Indications for LET with ACL Reconstruction

Indication

Rationale

Preferred Technique

High-grade pivot shift

Restores anterolateral restraint

Modified Lemaire LET

Revision ACLR

Reduces re-rupture risk

Modified MacIntosh

Generalized laxity

Controls tibial internal rotation

Iliotibial Band LET

High-demand athletes

Prevents graft overload

Hamstring + LET

Conclusion: The Auxein Vision

Lateral Extra-Articular Tenodesis combined with ACL Reconstruction represents the next step in restoring native knee biomechanics. By reducing rotational laxity and enhancing joint stability, this dual reconstruction ensures longevity and performance. Through continued innovation, simulation, and clinical partnership, Auxein is shaping the future of orthopedic biomechanics.

Key References

  • Nazzal EM et al. (2023). Curr Rev Musculoskelet Med.
  • Ra HJ et al. (2020). Arch Orthop Trauma Surg.
  • Rowan FE et al. (2019). Arch Orthop Trauma Surg.
  • Perelli S et al. (2023). Knee Surg Sports Traumatol Arthrosc.
  • Guenther D et al. (2017). JBJS.
  • Minguell JM et al. (2023). Eur Orthop Surg Traumatol.
  • Zanna L et al. (2023). Eur J Orthop Surg Traumatol.
  • Condello V et al. (2019). Knee Surg Sports Traumatol Arthrosc.
  • Vasiliadis AV et al. (2024). Singapore Med J.