Extra-Articular Tenodesis in Combination with Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is a successful procedure with high rates of return to sport. However, some patients experience persistent instability and graft failure. These adverse events have a significant impact, especially on high-level athletes. In an effort to improve outcomes for these patients, more attention is being paid to the anatomic structures at the anterolateral aspect of the knee. The anterolateral structures of the knee have been shown to play a major role in decreasing rotatory knee instability and forces across the ACL graft following reconstruction. This article discusses the indications and techniques for anterolateral ligament reconstruction or lateral extra-articular tenodesis, along with the newest anatomic and biomechanics concepts.