LET

Dr. Marx recently attended the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) biannual congress in Cancun, Mexico. At this meeting Dr. Alan Getgood presented the results of his multi-center Stability Study which was funded by ISAKOS in 2014. This study evaluated the use of lateral extraarticular tenodesis (LET) using iliotibial band (ITB) in anterior cruciate ligament reconstruction (ACLR).

LET used to be done in place of ACLR before surgeons went inside the knee to reconstruct the ACL. Now LET has become more popular as an additional procedure that is designed to increase the stability of the knee. Dr. Marx generally uses the LET procedure for high risk patients. This includes patients who are having revision ACLR and would like to return to cutting and pivoting sports, or patients who have had multiple revision surgeries. Additionally, he sometimes uses LET in primary ACLRs, when the patient is high risk due to age as well as other anatomical risk factors.

During this procedure, Dr. Marx first reconstructs the ACL using a piece of the patient’s own tissue (usually the patellar tendon or the hamstring tendons) and then does LET with ITB on the lateral side of the knee. Dr. Marx uses this procedure to decrease the risk of re-injury in patients who are already at a high risk for re-injury.

In Dr. Getgood’s study he randomized high risk patients to either receive ACLR alone, or ACLR+ LET. The goal was to determine if there was a decreased risk of re-injury in patients who had ACLR + LET. The study found that more patients in the group with only ACLR re-tore their ACL than patients in the ACLR+ LET group. This is further evidence that LET is a useful procedure to increase knee stability and decrease the risk of re-injury in high risk patients.

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