Lateral Extra-Articular Tenodesis

The ACL is one of the major knee ligaments that provides stability to the knee joint. When the ACL is torn or insufficient, it can lead to knee instability and an increased risk of further injury. In some cases, ACL reconstruction alone may not be sufficient to restore stability, especially in patients with certain anatomical or functional characteristics.

LEAT involves the reconstruction or reinforcement of the lateral side of the knee joint to enhance stability. The procedure typically involves utilizing a graft, which can be autograft (patient’s own tissue) or allograft (donor tissue), to reconstruct the lateral structures. The graft is often taken from the iliotibial band (ITB), a thick band of fibrous tissue located on the outer side of the thigh.

During the surgery, Dr. Petrigliano will secure the graft to the femur (thigh bone) and the tibia (shin bone) using various techniques such as tunnels, anchors, or other fixation devices. By restoring tension to the lateral structures of the knee, LEAT aims to provide additional stability and prevent excessive side-to-side movement of the knee joint which can reduce the risk of future injury.

LEAT is a good option when a person has certain problems with their knee, like when their tibia (shin bone) is tilted too much or there is generalized ligament laxity, and when they have other ligament injuries combined with ACL insufficiency. This procedure is also utilized in cases of revision ACL surgery or when the knee is very unstable.  It can help address excess rotational instability and improve overall knee function, making the knee stronger and more secure.  There is emerging evidence that the LEAT may reduce graft rupture rates after ACL reconstruction surgery.

The LEAT procedure is typically done in conjunction with an ACL reconstruction.  It does not typically add any increased time to the overall recovery after ACL reconstruction, however, you may take a bit longer to regain your knee flexion in the early stages of physical therapy.

Physical therapy plays a crucial role in the recovery process. Dr. Petrigliano will work with your physical therapist to create a rehabilitation plan based on your specific circumstances.  You will likely start with gentle exercises to improve mobility and strength, gradually progressing to more challenging exercises as your knee heals to restore balance and stability. Your physical therapist will guide you through each phase of recovery.

Typically, you can expect to regain basic functionality within a few weeks to a couple of months. However, it may take longer, around 8-12 months or more, to regain full strength and stability in your knee. Return to sports or high-impact activities may require additional time and depends on your individual progress, the nature of the activity, and the guidance of your healthcare team.

It’s important to follow Dr. Petrigliano’s and physical therapist’s instructions closely and be patient with the recovery process. It’s normal to experience ups and downs during rehabilitation and pushing yourself too hard or not following the recommended guidelines can hinder your recovery. Regular follow-up appointments with your healthcare team will allow them to monitor your progress and make adjustments to your rehabilitation plan as needed.