Knee procedures

Lateral Extra-articular Tenodesis (LET)

A lateral reinforcement added to ACL reconstruction in young athletes at high risk of a second tear.

A lateral extra-articular tenodesis is a small additional procedure on the outer side of the knee, performed at the same time as an ACL reconstruction. It uses a strip of the iliotibial band to add restraint against the rotational movement that an ACL graft alone has to resist. Dr. Green lists it among the techniques he performs, and the Hospital for Special Surgery is one of the first centres to use the modified Lemaire technique in children and teenagers.

Why it is added, and for whom

It is not part of every ACL reconstruction. It is considered for the young athlete whose examination, sport and anatomy put them at high risk of tearing the graft again — the group Dr. Green’s published work on the procedure is specifically about.

In a child who is still growing, the question is also whether it can be done at all without disturbing the growth plates. That is the question his research set out to answer, and it is why the anatomy is measured before the operation is planned.

How Dr. Green decides between surgery and non-surgical treatment

How Dr. Green uses a lateral extra-articular tenodesis

Modified Lemaire lateral extra-articular tenodesisThe technique he has published on in high-risk adolescents undergoing ACL reconstruction.
Performed alongside the ACL reconstructionAn addition to the reconstruction, not a replacement for it.
Planned against paediatric anatomyHis group published reference anatomy for exactly this decision in the growing knee.

6 peer-reviewed papers on the lateral extra-articular tenodesis

Dr. Green's published research on the lateral extra-articular tenodesis

Of the papers indexed on PubMed under Dr. Green’s Hospital for Special Surgery affiliation, 6 are on this subject. His group has also compared the lateral extra-articular tenodesis with anterolateral ligament reconstruction in skeletally immature patients, and reported on graft maturity on MRI two years after ACL reconstruction with a LET.

See the full publication record

In Dr. Green’s own words

It is one of the first studies that shows in young kids who are growing, with open growth plates, it can be done safely.

— Dr. Daniel W. Green, quoted in ACL reconstruction with novel technique linked with 92% return to sport in some teenagers, HSS Newsroom, 26 April 2022

The papers themselves

His 6 papers on this subject, indexed on PubMed under his Hospital for Special Surgery affiliation. Each opens on PubMed.

Questions parents ask

Does every ACL reconstruction need a LET?

No. It is an addition considered for young athletes at high risk of injuring the graft again. Whether it applies is decided at the consultation, from the examination, the sport and the imaging.

Can it be done in a child who is still growing?

That is the question Dr. Green’s research addressed in children and teenagers with open growth plates. His findings, and the results the study reported, are set out in the coverage linked from this site.