Anterolateral Stabilization
Lateral Extra-articular
Tenodesis (LET) to control
knee rotation
Opportunity to improve
Anterior Cruciate Ligament
(ACL) reconstruction
• ACL re-rupture rates can be as high as 25% in young males1
• Reviews of ACL reconstruction (ACLR) show that 15% have
a residual ‘pivot-glide’ laxity (anterior translation and internal
rotation)2
• Anterolateral complex is injured in up to 90% of ACL injuries3-6
Internal rotation at 50° flexation7 L
ET Procedures restore
18 biomechanics**
16
• Deep Lemaire and McIntosh procedures
14
restore knee kinematics (internal rotation
Internal Rotation (degrees)
12 and anterior translation) after ACL and
10 anterolateral complex injury7
8
6
• LET procedures reduced rotational and
translational laxity better than anterolateral
4
ligament (ALL) reconstruction7,8
2
0 • LET procedures should have a graft tension
ALL Intact Lamaire McIntosh Lamaire
Reconstruction* ACL + ALC Deep Superficial* of 20N and be performed in neutral rotation
to avoid overconstraint of the knee9
* Statistically significant difference from intact state
** Based on laboratory cadaveric studies.
Anterolateral Stabilization | Lateral Extra-articular Tenodesis (LET) to control knee rotation
Reduced failures with ACLR + LET Patient selection is key
vs ACLR in high risk patients11 • Consensus groups states possible indications for
50% additional anterolateral stabilization10:
ACLR • Revision ACL
40%
ACLR+LET
• High grade pivot shift
• Generalized ligamentous laxity
30%
• Young patients returning to pivoting activities
20% • LET can significantly reduce pivot shift and failure
rates of revision ACL reconstructions from 37% to
10%
20% and 15% to 7% of patients, respectively11
0% • Adding LET procedures to ACLR in high risk patients
Clinical Failure Graft Rupture significantly reduces clinical and graft failure rates
from 40% to 25% and 11% to 4%, respectively12
F
ixation placement and strength with
LET and BIOSURE◊ REGENESORB◊
interference screw
• LET requires only a single fixation point with an interference
screw and can restore normal knee kinematics when fixed at
any flexion angle9
• BIOSURE REGENESORB screw features advanced biocomposite
material with an open-architecture design to allow for bone
ingrowth*, which also provides the kind of fixation strength
expected with a solid absorbable interference screw**13-15
• REGENESORB material is absorbed and effectively replaced
by bone within 24 months in clinical and pre-clinical studies16-18
* As demonstrated in vivo
** Compared to BIOSURE HA interference screws; as demonstrated in benchtop testing
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References
1. Feller J, Webster KE. Fate of the Young Patient Undergoing Anterior Cruciate Ligament Reconstruction: Exploring the High Re-Injury Rate. Orthop. J. Sports Med. 2019;4(2Suppl).
2. Freedman KB, D’Amato MJ, Nedeff D, Kaz A, Bach BR. Arthroscopic Anterior Cruciate Ligament Reconstruction: A Metaanalysis Comparing Patellar Tendon and Hamstring Tendon
Autografts. AJSM 2003;31(1):2-11. 3. Mansour R, Yoong P, McKean D, The JL. The iliotibial band in acute knee trauma: patterns of injury on MR imaging. Skeletal Radiol 2014;43:1369
–1375. 4. Cavaignac E, Faruch M, Wytrykowski K, et al. Ultrasonographic Evaluation of Anterolateral Ligament Injuries: Correlation With Magnetic Resonance Imaging and Pivot-Shift
Testing. Arth 2017;33(7):1384-1390. 5. Ferretti A, Monaco E, Fabbri M, et al. Prevalence and Classification of Injuries of Anterolateral Complex in Acute Anterior Cruciate Ligament
Tears. Arth 2016;33(1):147-154. 6. Healito CP, Helito PVP, Costa HP, et al. Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging in Acute Injuries
of the Anterior Cruciate Ligament. Arth 2016;33(1):140-146. 7. Inderhaug E, Stephen JM, Williams A, Amis AA. Biomechanical Comparison of Anterolateral Procedures Combined
With Anterior Cruciate Ligament Reconstruction. AJSM 2016;45(2):347-354. 8. Spencer L, Burkhart TA, Tran MT, et al. Biomechanical Analysis of Simulated Clinical Testing and
Reconstruction of the Anterolateral Ligament of the Knee. AJSM 2015;43(9):2189-2197. 9. Inderhaug E, Stephen JM, Williams A, Amis AA. Anterolateral Tenodesis or Anterolateral
Ligament Complex Reconstruction. AJSM 2017;45(13):3089-3097. 10. Getgood A, Brown C. Lording T, et al. The anterolateral complex of the knee: results from the International
ALC Consensus Group Meeting. ESSKA 2019;27:166–176. 11. Trojani C, Beaufils P, Burdin G, et al. Revision ACL reconstruction: influence of a lateral tenodesis. Knee Surg Sports
Traumatol Arthrosc 2012;20:1565–1570. 12. Getgood AMJ, Bryan DM, Litchfield R, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior
Cruciate Ligament Reconstruction AJSM 2020;48(2):285-297. 13. S+N 2015. BIOSURE REGENESORB ovine ACL implantation study NCS250. 14. S+N 2014. Verif, BIOSURE HA
Screw Fixation Strength and Insertion 15002832 Revision A. 15. S+N 2017. Verification & Validation, BIOSURE REGENESORB Interference Screws 15004843 Revision F.
16. Vonhoegen J, John D, Hägermann C. Osteoconductive resorption characteristics of a novel biocomposite suture anchor material in rotator cuff repair. Orthop Traumatol Surg Res.
2019;14(1):12. 17. S+N 2010. Micro-CT and histological evaluation of specimens from resorbable screw study (RS-II / OM1-08) 24-month post-implantation. Internal Report
WRP-TE045-700-08. 18. S+N 2016. Healicoil Regenesorb Suture Anchor – a study to assess implant replacement by bone over a 2 year period. NCS248.
