{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T19:51:56Z","timestamp":1793389916433,"version":"4.5.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Essential Surgical Techniques"],"abstract":"\n Background:<\/jats:title>\n A modified Lemaire lateral extra-articular tenodesis (LET) is a procedure that is designed to address anterolateral complex (ALC) deficiency. The procedure is performed as an augmentation to anterior cruciate ligament reconstruction (ACLR) to reduce anterolateral rotatory laxity. Studies have demonstrated improved rotational control and reduced failure rates of ACLR when LET is added. This is particularly helpful in young patients with high-grade rotatory laxity returning to contact pivoting sport, and in the revision ACLR scenario.<\/jats:p>\n <\/jats:sec>\n \n Description:<\/jats:title>\n A 6-cm skin incision is placed just posterior to the lateral epicondyle. The subcutaneous tissue is dissected down to the iliotibial band (ITB). A 1-cm-wide by 8-cm-long strip of the posterior half of the ITB is fashioned, leaving the distal attachment at Gerdy\u2019s tubercle intact. The free end is whipstitched with number-1 Vicryl suture, tunneled deep to the fibular collateral ligament (FCL), and attached to the metaphyseal flare of the lateral femoral condyle at the insertion of the distal Kaplan fibers of the ITB. Fixation is performed with a staple, with the graft tensioned to no more than 20 N (by simply holding it taut and not \u201ctensioned\u201d), with the knee held at 60\u00b0 of flexion and neutral rotation of the tibia.<\/jats:p>\n <\/jats:sec>\n \n Alternatives:<\/jats:title>\n A number of procedures to address ALC deficiency have been described. The most common methods currently are variations of the ITB LET (Lemaire [ITB graft detached proximally, passed under the FCL, and attached to the femur] or Ellison [ITB graft detached distally, passed deep to the FCL, and reattached at Gerdy\u2019s tubercle]) or anterolateral ligament reconstructions. No clinical studies have been performed that demonstrate that one technique is superior to another.<\/jats:p>\n <\/jats:sec>\n \n Rationale:<\/jats:title>\n Current ACLR procedures focus on intra-articular graft placement to replace the ACL. Unfortunately, high rates of graft failure and persistent rotatory laxity (pivot shift) have been observed, particularly in young, high-demand individuals returning to contact pivoting sport. ALC deficiency has been shown to be a major cause of high-grade anterolateral rotatory laxity. The LET procedure is therefore designed to augment ACLR and reduce anterolateral rotation. The aim of adding LET to ACLR is to reduce the strain on the ACLR graft, reduce the prevalence of the pivot shift, and thereby potentially reduce the rate of ACLR graft failure.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.st.19.00017","type":"journal-article","created":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T15:00:42Z","timestamp":1574780442000},"page":"e41","source":"Crossref","is-referenced-by-count":117,"title":["Modified Lemaire Lateral Extra-Articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction"],"prefix":"10.2106","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9768-0257","authenticated-orcid":false,"given":"Satyen","family":"Jesani","sequence":"first","affiliation":[{"name":"Department of Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-4333","authenticated-orcid":false,"given":"Alan","family":"Getgood","sequence":"additional","affiliation":[{"name":"Department of Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019]]},"reference":[{"issue":"10","key":"bib1-20230808","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1016\/j.arthro.2015.04.089","article-title":"Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature","volume":"31","author":"Hewison","year":"2015","journal-title":"Arthroscopy."},{"issue":"1","key":"bib2-20230808","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s00167-018-5072-6","article-title":"The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting","volume":"27","author":"Getgood","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"6","key":"bib3-20230808","doi-asserted-by":"crossref","first-page":"882","DOI":"10.2106\/00004623-199173060-00010","article-title":"The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament","volume":"73","author":"Noyes","year":"1991","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib4-20230808","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1177\/03635465010290030201","article-title":"Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods","volume":"29","author":"Anderson","year":"2001","journal-title":"Am J Sports Med."},{"issue":"1","key":"bib5-20230808","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/036354659101900104","article-title":"The iliotibial band lateral sling procedure and its effect on the results of anterior cruciate ligament reconstruction","volume":"19","author":"O\u2019Brien","year":"1991","journal-title":"Am J Sports Med."},{"issue":"4","key":"bib6-20230808","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1177\/0363546508328114","article-title":"Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up","volume":"37","author":"Marcacci","year":"2009","journal-title":"Am J Sports Med."},{"issue":"6","key":"bib7-20230808","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1177\/0363546509361018","article-title":"Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation","volume":"38","author":"Pernin","year":"2010","journal-title":"Am J Sports Med."},{"issue":"8","key":"bib8-20230808","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1007\/s11999-015-4285-y","article-title":"Does combined intra- and extraarticular ACL reconstruction improve function and stability? A meta-analysis","volume":"473","author":"Rezende","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib9-20230808","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.arthro.2015.08.038","article-title":"Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon","volume":"32","author":"Song","year":"2016","journal-title":"Arthroscopy."},{"issue":"10","key":"bib10-20230808","doi-asserted-by":"crossref","first-page":"2325967117731767","DOI":"10.1177\/2325967117731767","article-title":"The role of lateral extra-articular tenodesis in primary anterior cruciate ligament reconstruction: a systematic review with meta-analysis and best-evidence synthesis","volume":"5","author":"Devitt","year":"2017","journal-title":"Orthop J Sports Med."},{"issue":"4","key":"bib11-20230808","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1007\/s00167-017-4510-1","article-title":"Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of osteoarthritis: a systematic review and best evidence synthesis","volume":"25","author":"Devitt","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"10","key":"bib12-20230808","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1016\/j.arthro.2016.02.006","article-title":"Combined intra-articular and extra-articular reconstruction in anterior cruciate ligament-deficient knee: 25 years later","volume":"32","author":"Ferretti","year":"2016","journal-title":"Arthroscopy."},{"issue":"2","key":"bib13-20230808","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/036354659001800210","article-title":"The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion","volume":"18","author":"Engebretsen","year":"1990","journal-title":"Am J Sports Med."},{"issue":"3","key":"bib14-20230808","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/0363546517745268","article-title":"Anterolateral knee extra-articular stabilizers: a robotic study comparing anterolateral ligament reconstruction and modified Lemaire lateral extra-articular tenodesis","volume":"46","author":"Geeslin","year":"2018","journal-title":"Am J Sports Med."}],"container-title":["JBJS Essential Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.ST.19.00017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:38:59Z","timestamp":1787751539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.ST.19.00017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.st.19.00017","relation":{},"ISSN":["2160-2204"],"issn-type":[{"value":"2160-2204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019]]}}}