Anterior Cruciate Ligament (ACL) Tears: Lateral Extra-Articular Tenodesis (LET)

Anterior Cruciate Ligament (ACL) Tears: Lateral Extra-Articular Tenodesis (LET)

Speaker1: This surgical video demonstrates a lateral extra-articular tenodesis, or LET procedure. This procedure involves cutting and repositioning part of the iliotibial, or IT band, at the outer side of the knee. It is completed in addition to an anterior cruciate ligament reconstruction, to reinforce the stability of the knee joint following surgery.

Here we see a left knee with the outer side of the knee facing the screen. The surgeon has already used a skin marker to mark out where the incision will be made. The surgeon begins by cutting through the skin and underlying soft tissue to expose the IT band. The surgeon cuts a 1cm wide section of the IT band, ties a suture to the end, and continues to cut until the graft is long enough. The graft is set to the side.

The surgeon cuts through a layer of soft tissue and finds the lateral collateral ligament, or LCL. An angled clamp is used to pass the graft suture underneath this ligament. The suture is pulled to pass the graft underneath the ligament.

Next, the surgeon uses a drill and drill guide to create a hole in the thigh bone, or femur, for an anchor. The anchor is placed into the guide and malleted it into the bone. The anchor is already threaded with sutures with loops in place. The graft is passed into one of the loops, and the suture loop is tightened to bring the graft tight to the bone.

The graft is passed back through the second loop and tightened to bone once again. The sutures are cut. The incision will be closed with sutures, and the procedure is complete.