13. Introducing OVERTIME: Lateral Extra-articular Tenodesis (LET)

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and Ashley chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the indications, various surgical approaches and overview of the outcomes. We’re excited to bring this new styles to our listeners and would love to hear your feedback about it!On this Overtime episode, we’re going to chat about extra articular augmentation of ACL reconstruction, specifically focusing on lateral extra articular tenodesis. The need for this procedure arose due to the concern that even our best “anatomic” ACL reconstructions often fail restore rotational control, resulting in a persistently positive pivot shift test, which has been strongly associated with worse clinical outcomes, increased functional instability, possibly even increased arthritic changes.Enjoy these brief, research updates in a casual discussion setting!The history of Lateral Extraarticular Tenodesis (LET)In the 1960s ACL reconstructions were limited to open techniques as this was before key hole surgery (arthroscopy) and they involved rerouting the patella tendon to provide stabilityHowever, this resulted in such poor outcomes that alternative techniques were soughtIn 1967 Dr Marcel Lemaire was the first to describe an isolated LET to help reduce rotational instability This involved an 18 x 1cm wide strip of iliotibial band and rerouting it around the outside part of the knee With the advent of arthroscopic ACL reconstruction techniques, the benefit of smaller scars and less pain, LET was thought to be unnecessaryIncreasing medical evidence though has shown that whilst isolated ACL reconstruction may be adequate for lower demand athletes, new modified LET procedures help to significantly improve rotational stability to an arthroscopic ACL reconstruction