Lateral Extra-articular Tenodesis

What is Lateral Knee Extra-articular Tenodesis?

Lateral knee extra-articular tenodesis is a surgical procedure performed to address instability or excessive lateral movement of the knee joint. The procedure involves reinforcing the lateral side of the knee by reconstructing or strengthening one or more of the tendons that help stabilize the knee. These tendons are often the iliotibial (IT) band, lateral collateral ligament (LCL), or other nearby structures.

The goal of lateral knee extra-articular tenodesis is to improve knee stability, especially in cases where there is a risk of recurrent dislocations or excessive lateral motion during activities. It is commonly performed in conjunction with other knee surgeries, such as anterior cruciate ligament (ACL) reconstruction, to enhance overall knee stability and function.

What are the Indications for Lateral Knee Extra-articular Tenodesis?

Lateral knee extra-articular tenodesis is typically indicated in several situations where there is instability or excessive lateral movement of the knee joint that cannot be adequately addressed by other means.

Some common indications for this procedure include:

• Anterior cruciate ligament reconstruction surgery to enhance lateral stability and reduce the risk of pivot shift phenomenon, especially in cases where there is significant lateral laxity
• Injuries involving multiple ligaments of the knee, especially when there is combined ACL and lateral collateral ligament (LCL) instability
• Patients with recurrent episodes of knee subluxations or dislocations due to lateral instability
• In cases of chronic degenerative changes or laxity in the lateral ligaments of the knee
• Revision knee surgery where previous knee surgeries have not adequately addressed lateral instability or have resulted in persistent symptoms
• High-demand activities, such as athletes who engage in high-demand sports that require cutting, pivoting, or rapid changes in direction
• When conservative treatments like physical therapy fail to improve lateral knee stability

What is the Procedure for Lateral Knee Extra-articular Tenodesis?

In general, the procedure for lateral knee extra-articular tenodesis may involve the following steps:

• You will be placed under either general anesthesia or regional anesthesia to ensure you are comfortable and pain-free during the procedure.
• You will be positioned on the operating table in a way that allows optimal access to the knee joint for the surgical team. This typically involves lying on your back with the knee flexed.
• The surgeon makes an incision on the lateral side of the knee to access the structures that need reinforcement, such as the iliotibial band (ITB) and the lateral collateral ligament (LCL).
• The surgeon carefully identifies and prepares the tissues that will be used for the tenodesis. This can include harvesting a portion of the ITB or using other nearby tendons for reinforcement.
• The chosen tissue (often a part of the ITB) is then secured and anchored in a specific location to provide additional support and stability to the lateral aspect of the knee joint. This can be done using sutures, screws, or other fixation devices.
• After the tenodesis is completed, the incision is closed with sutures or staples. Sterile dressings are applied to the surgical site.

What Does Postoperative Care for Lateral Knee Extra-articular Tenodesis Involve?

After surgery, you will be taken to the recovery room where medical staff will monitor your vital signs and ensure you wake up safely from anesthesia. After waking up, you will receive instructions on postoperative care, including pain management to keep you pain-free, activity restrictions to reduce swelling and promote healing, wound care to keep the surgical incisions clean and dry, diet and nutrition to support healing and recovery, and medication management to prevent infection and manage inflammation. You will undergo a structured rehabilitation program usually within the first few days to weeks after surgery. This program includes exercises to restore knee mobility, strength, and function. Your orthopedic surgeon will schedule follow-up appointments to monitor your progress, assess the success of the surgery, and make any necessary adjustments to your rehabilitation plan.

What are the Risks and Complications of Lateral Knee Extra-articular Tenodesis?

Risks and complications associated with lateral knee extra-articular tenodesis may include:

• Infection
• Bleeding
• Hematoma (collection of blood) around the surgical site
• Nerve or blood vessel injury
• Stiffness or reduced range of motion
• Persistent pain
• Allergic reactions/adverse reactions to anesthesia
• Graft failure or rupture
• Deep vein thrombosis (DVT) or pulmonary embolism (PE), which are serious blood clotting complications