Lateral Extra-Articular Tenodesis - The Argument Against

Description

In this presentation, Nick Nicolaou discusses the complexities and controversies surrounding lateral extra-articular procedures (LET) in the context of anterior cruciate ligament (ACL) reconstruction. He opens by establishing a collegial rapport with his audience, hinting that the talk won't be filled with traditional hype or sensational revelations. He acknowledges a growing debate about the necessity and effectiveness of lateral tenodesis, citing stability trial outcomes that raise questions about its utility.



Nicolaou emphasizes the importance of a deeper understanding of knee kinematics and surgery, warning against reliance on new procedures without solid evidence. He recalls the historical example of hip resurfacing, which faced early promise followed by disillusionment due to high failure rates—drawing parallels to current practices.



He touches on pediatric procedures, highlighting their historical context, and presents findings from various studies that indicate favorable outcomes associated with lateral extra-articular techniques when appropriately performed on selected patients. However, he raises concerns about long-term osteoarthritis risks associated with lateral tenodesis, calling for more rigorous studies to evaluate treatment protocols.



The discussion expands to address the multifactorial nature of knee stability and the role of associated injuries, particularly in younger patients—encouraging the audience to think critically about surgical indications and biomechanical factors at play. He concludes by advocating for further research and collaborative efforts to refine techniques and improve patient outcomes, emphasizing the critical need to analyze the implications of current practices on long-term health.

DOI: 10.1302/3114-230387

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