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A Simple Tenodesis for Severe Rotatory Instbility in an Anterior Cruciate Ligament-Deficient Knee

February 01, 2014

Contributors: Raffaele Iorio, MD; Cosma Calderaro, MD; Daniele Mazza, MD; Carmelo D'Arrigo; Andrea Ferretti, MD; Fabio Conteduca, MD; Fabio Conteduca, MD

Extra-articular reconstructions, either isolated or in association with intra-articular reconstruction, were popular in the 1980s worldwide. However, they were almost discontinued as a result of the publication of the proceedings of a consensus conference organized by the American Orthopaedic Society for Sports Medicine in 1992, at which the authors concluded that extra-articular reconstructions could not provide improvement in clinical results and were associated with increased morbidity and higher risk for complications. Since then, the approach to anterior cruciate ligament (ACL) reconstruction has radically changed: Arthroscopically assisted techniques and accelerated rehabilitation represent the standards. Extra-articulars have been reconsidered for use in association with intra-articulars in select cases involving severe rotatory instability, high-level athletics (especially women), and revision ACL surgery. The aim of this video is to present a simple extra-articular technique as described by Coker and Arnold as a modified McIntosh procedure in association with anatomic intra-articular ACL reconstruction with hamstrings. The association of a lateral tenodesis, according to MacIntosh and as modified by the Coker-Arnold procedure, with an anatomically placed intra-articular reconstruction with hamstrings improves knee stability, reduces risk for recurrence, and does not increase the rate of osteoarthritis in selected cases of ACL-deficient knees.

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