Revision ACL-R With Contralateral BTB Autograft and Iliotibial Band Lateral Extra-Articular Tenodesis With Interference Screw Fixation: A Technique Video

Abstract

Background: Lateral extra-articular tenodesis (LET) is a reproducible and reliable technique to assist in control of rotational stability of the knee and decrease forces across an anterior cruciate ligament (ACL) graft in the setting of ACL reconstruction. Bone-tendon-bone (BTB) autograft is a common graft choice in revision ACL reconstruction. We present a technique for combining contralateral BTB autograft with LET in revision ACL reconstruction. Indications: This technique is indicated in patients undergoing ACL reconstruction who are at increased risk of graft failure, including revision cases, high-grade rotational instability, return to pivoting/cutting sports, ligamentous laxity, young age, meniscal deficiency, and hyperextension/recurvatum. Technique Description: The contralateral BTB autograft is harvested through standard fashion. We begin with the LET dissection prior to fluid infiltration in the soft tissues. A 1-cm strip of iliotibial (IT) band is harvested and whipstitched. The IT band strip is passed from anterior to posterior deep to the lateral collateral ligament (LCL). The LET socket is aimed 10° proximal and 10° anterior to limit tunnel convergence with the ACL. The LET is fixed with a tenodesis screw with the knee in neutral rotation and 30° of flexion. The ACL femoral socket is then placed, and care is taken to avoid convergence. A 10-mm tibial tunnel is drilled near the level of the posterior margin of the anterior horn of the lateral meniscus. The ACL is subsequently fixed with standard techniques. Results: The addition of LET to revision ACL has been shown to improve failure rate and outcomes. The use of contralateral patella tendon graft reduces morbidity on the operated leg. Notably, the position of the femoral LET tunnel is less important than the ACL tunnel position on the femur. If the LET is passed under the LCL, then the fixation point on femur becomes less relevant. The technique presented is a time-efficient way for combining tenodesis with revision ACL. Discussion/Conclusion: Performing a revision ACL reconstruction utilizing contralateral donor tissue with the addition of LET is a viable and reliable option for competitive athletes. 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.