What is lateral extra-articular tenodesis (LET)?
Lateral extra-articular tenodesis (LET) is a specialized procedure performed for patients who suffer anterior knee instability following an injury to the ACL and the anterolateral ligament complex. Injury to multiple ligaments in this complex or repeated injury to the complex can result in instability and laxity, or excessive flexibility. LET is an extra-articular procedure that aids in preventing anterior knee instability during pivoting activities. LET is performed most frequently in conjunction with ACL reconstruction in hyperlax individuals, skeletally immature individuals and individuals undergoing revision ACL reconstruction. The iliotibial band Tenodesis and the LET are equivalent.
The LET operation is an open surgery: during this procedure, the iliotibial band (ITB) is exposed near the knee joint. The distal insertion of the ITB is preserved and a 1 cm wide by 10-12 cm strip of tissue is harvest. The ITB strip is passed under the lateral collateral ligament (LCL) and secured in place on the distal lateral femur above the knee joint. The orientation of the LET mimics that of the ACL graft and adds further strength to the knee stabilizing construct. As this procedure typically accompanies ACL reconstruction, typical postoperative rehabilitation protocols are followed. Crutch use is recommended for two weeks, and weight-bearing activities are progressed subsequently. The goal of LET or lateral extra-articular tenodesis is to retain the patient’s full range of motion while increasing stability and preventing further injury to the anterolateral complex of the knee. ITB tenodesis may be indicated if the patient is at a high-risk of retearing the ACL, such as athletes participating in contact supports, or individuals who participate in activities involving frequent pivots, turns, or jumps.
A return to full athletic activities is expected 6-8 months following LET / IT band Tenodesis.