Anterior Cruciate Ligament Reconstruction in Combination With an Extra-Articular Tenodesis

Rotatory instability of the knee is very often associated with the anteroposterior laxity in the anterior cruciate ligament (ACL)-deficient knee and it is most probably caused by lesions of the anterolateral structures such as the capsule and anterolateral ligament. If underdiagnosed or undertreated with isolated ACL reconstruction, this residual instability may lead to reinjury of premature arthritis. This article focuses on the role of lateral extra-articular tenodesis in reestablishing dynamic stability when performed together with ACL reconstruction; then it describes our preferred surgical technique, which always associates ACL and lateral extra-articular tenodesis, and discusses it with other surgical options described in literature.