Kinetic and Kinematic analysis of ACL reconstruction in association with lateral-extrarticular tenodesis of the knee in revision surgery: a pilot study

Main Article Content

Paolo Di Benedetto
Michele Mario Buttironi
Francesco Mancuso
Federico Roman
Daniele Vidi
Araldo Causero


Anterior cruciate ligament, revision, lateral extrarticular tenodesis, reconstruction, kinematic



Anterior cruciate ligament reconstructions are a very frequent surgery. The key role of the anterolateral ligament in the knee rotational stability has been undelighted in recent years. Extra-articular tenodesis in association with ACL reconstructions, serves to eliminate anterolateral rotatory instability. The aim of our study is to compare treated knees with the contralateral uninjured knee in those cases whom been treated with ACL arthroscopic reconstruction and lateral extra-articular tenodesis in revision surgery, and evaluate clinical results with kinematic and kinetic examinations methods.

Materials and methods

Sixteen patients (10 males and 6 females) with ages from 21 to 37 had been treated at the Orthopaedic Clinic of Udine for failure of previous ACL reconstruction. In all patients was performed ACL arthroscopic reconstruction with the association of a lateral extra-articular tenodesis (Coker-Arnold). We have decided to asses the patients at one year after surgery with GNRB arthrometer and Bioval inertial sensor system.


All patients treated with arthroscopic ACL reconstruction and lateral extra-articular tenodesis have regained pre-injury sagittal knee stability and gait dynamics.


Download data is not yet available.
Abstract 121 | PDF Downloads 62


1. Gottlob CA, Baker CL, Jr., Pellissier JM, Colvin L. Cost effectiveness of anterior cruciate ligament reconstruction in young adults. Clin Orthop Relat Res 1999:272-82.
2. Andernord D, Desai N, Bjornsson H, Ylander M, Karlsson J, Samuelsson K. Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up. Am J Sports Med 2015;43:121-7.
3. Maletis GB, Granan LP, Inacio MC, Funahashi TT, Engebretsen L. Comparison of community-based ACL reconstruction registries in the U.S. and Norway. J Bone Joint Surg Am 2011;93 Suppl 3:31-6.
4. Di Benedetto P, Buttironi MM, Mancuso F, Beltrame A, Gisonni R, Causero A. Anterior cruciate ligament reconstruction: the role of lateral posterior tibial slope as a potential risk factor for failure. Acta Biomed 2020;91:e2020024.
5. Christensen JJ, Krych AJ, Engasser WM, Vanhees MK, Collins MS, Dahm DL. Lateral Tibial Posterior Slope Is Increased in Patients With Early Graft Failure After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2015;43:2510-4.
6. Woo SL, Kanamori A, Zeminski J, Yagi M, Papageorgiou C, Fu FH. The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon . A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 2002;84:907-14.
7. Getgood A, Hewison C, Bryant D, et al. No Difference in Functional Outcomes When Lateral Extra-Articular Tenodesis Is Added to Anterior Cruciate Ligament Reconstruction in Young Active Patients: The Stability Study. Arthroscopy 2020;36:1690-701.
8. Slette EL, Mikula JD, Schon JM, et al. Biomechanical Results of Lateral Extra-articular Tenodesis Procedures of the Knee: A Systematic Review. Arthroscopy 2016;32:2592-611.
9. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013;223:321-8.
10. Terry GC, Norwood LA, Hughston JC, Caldwell KM. How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med 1993;21:55-60.
11. Di Benedetto P, Di Benedetto E, Fiocchi A, Beltrame A, Causero A. Causes of Failure of Anterior Cruciate Ligament Reconstruction and Revision Surgical Strategies. Knee Surg Relat Res 2016;28:319-24.
12. Vundelinckx B, Herman B, Getgood A, Litchfield R. Surgical Indications and Technique for Anterior Cruciate Ligament Reconstruction Combined with Lateral Extra-articular Tenodesis or Anterolateral Ligament Reconstruction. Clin Sports Med 2017;36:135-53.
13. Benum P. Extracondylar transposition of the lateral third of the patellar ligament in anterolateral rotatory instability of the knee. Presented at the 43rd Meeting of the Scandinavian Orthopaedic Association, Trondheim, Norway. 1986.
14. Di Benedetto P, Vidi D, Colombo A, Buttironi MM, Cainero V, Causero A. Pre-operative and post-operative kinematic analysis in total knee arthroplasty. A pilot study. Acta Biomed 2019;90:91-7.
15. Engebretsen L, Lew WD, Lewis JL, Hunter RE. The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med 1990;18:169-76.
16. Andrews JR, Sanders R. A "mini-reconstruction" technique in treating anterolateral rotatory instability (ALRI). Clin Orthop Relat Res 1983:93-6.
17. Arnold JA, Coker TP, Heaton LM, Park JP, Harris WD. Natural history of anterior cruciate tears. Am J Sports Med 1979;7:305-13.
18. Jenny JY, Puliero B, Schockmel G, Harnoist S, Clavert P. Experimental validation of the GNRB((R)) for measuring anterior tibial translation. Orthop Traumatol Surg Res 2017;103:363-6.
19. Andrews JR, Sanders RA, Morin B. Surgical treatment of anterolateral rotatory instability. A follow-up study. Am J Sports Med 1985;13:112-9.
20. Dejour H, Walch G, Neyret P, Adeleine P. [Results of surgically treated chronic anterior laxities. Apropos of 251 cases reviewed with a minimum follow-up of 3 years]. Rev Chir Orthop Reparatrice Appar Mot 1988;74:622-36.
21. Lemaire M. Ruptures anciennes du ligament croise anterieur. Frequence-clinique traitement. . J Chir 1967;93:311-320.
22. Rackemann S, Robinson A, Dandy DJ. Reconstruction of the anterior cruciate ligament with an intra-articular patellar tendon graft and an extra-articular tenodesis. Results after six years. J Bone Joint Surg Br 1991;73:368-73.
23. MacIntosh DL DT. Lateral substitution reconstruction. J Bone Joint Surg Br 1986;58B:142.
24. Bertoia JT, Urovitz EP, Richards RR, Gross AE. Anterior cruciate reconstruction using the MacIntosh lateral-substitution over-the-top repair. J Bone Joint Surg Am 1985;67:1183-8.
25. Zarins B, Rowe CR. Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract. J Bone Joint Surg Am 1986;68:160-77.
26. Anderson AF, Snyder RB, Lipscomb AB, Jr. Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 2001;29:272-9.
27. Devitt BM, Bouguennec N, Barfod KW, Porter T, Webster KE, Feller JA. 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. Knee Surg Sports Traumatol Arthrosc 2017;25:1149-60.
28. Amis AA, Scammell BE. Biomechanics of intra-articular and extra-articular reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 1993;75:812-7.

Most read articles by the same author(s)

1 2 3 4 > >>