What the study found
The study found that anterior cruciate ligament reconstruction (ACL reconstruction, a surgical repair of the main knee ligament) alone did not fully restore knee stability in cadaveric knees. Adding lateral extra-articular tenodesis (a procedure that reinforces the outer side of the knee) restored several stability measures to levels comparable with the intact knee, and lateral meniscus posterior root repair was especially important for valgus rotation during pivot shift.
Why the authors say this matters
The authors conclude that both lateral meniscus posterior root repair and anterolateral corner reconstruction are needed to restore stability in knees with anterior cruciate ligament, Kaplan fiber, and lateral meniscus posterior root injuries. The study suggests these structures play secondary stabilizing roles in internal rotation and pivot shift loading.
What the researchers tested
The researchers studied ten paired cadaveric knees in a six degrees of freedom robotic system. They sequentially sectioned the anterior cruciate ligament, lateral meniscus posterior root, and Kaplan fibers, then tested the knees after anterior cruciate ligament reconstruction, lateral meniscus posterior root repair, modified Lemaire lateral extra-articular tenodesis, or combinations of these procedures. Tibial displacement and rotation were measured under internal rotation torque and a simulated pivot shift from 0° to 90° of knee flexion.
What worked and what didn't
Anterior cruciate ligament reconstruction alone left significant residual increases in isolated internal rotation, coupled internal rotation, coupled anterior tibial translation, and coupled valgus rotation during pivot shift. Adding modified Lemaire lateral extra-articular tenodesis, with or without lateral meniscus posterior root repair, restored isolated internal rotation, coupled internal rotation, and coupled anterior tibial translation to values comparable with the intact knee. Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction and Kaplan fiber injury restored valgus rotation stability at most flexion angles.
What to keep in mind
This was a cadaveric biomechanical study, so the findings describe mechanical behavior rather than patient outcomes. The abstract does not describe clinical follow-up, and it does not provide limitations beyond the study setting.
Key points
- ACL reconstruction alone did not fully restore knee stability in the cadaveric knees.
- Adding modified Lemaire lateral extra-articular tenodesis restored several stability measures to levels comparable with the intact knee.
- Lateral meniscus posterior root repair was most important for valgus rotation stability during pivot shift.
- Kaplan fibers contributed additively to internal rotation and pivot shift loading in the ACL-deficient knee.
- The study used ten paired cadaveric knees tested in a robotic system across 0° to 90° of knee flexion.
Disclosure
- Research title:
- Lateral extra-articular tenodesis improved stability after ACL reconstruction
- Authors:
- Wybren A. van der Wal, Luke V. Tollefson, Roy A.G. Hoogeslag, Erik L. Slette, Mitchell Carlson, Evan P Shoemaker, Robert F. LaPrade
- Institutions:
- OCON Orthopedische kliniek, Twin Cities Orthopedics, Twin Cities Orthopedics, Twin Cities Orthopedics, Twin Cities Orthopedics, Twin Cities Orthopedics, Ziekenhuis Gelderse Vallei
- Publication date:
- 2026-04-23
- DOI:
- 10.1002/arj.70172
- OpenAlex record:
- View
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