Editorial Commentary: Lateral Extra-articular Procedures Concomitant to Anterior Cruciate Ligament Reconstruction Must Balance Clinical Efficacy and the Risk of Kinematic Restraint.

Abstract

Lateral extra-articular procedures (LEAPs) performed concomitant to anterior cruciate ligament reconstruction improve clinical outcomes and can restore normal knee kinematics. However, some LEAPs may result in overconstraint depending on technique. When using an iliotibial band based technique, passing the graft deep to the lateral collateral ligament and fixing it on the lateral cortex (rather than in a tunnel with an interference screw) minimizes the risk of tunnel collision and may also reduce the risk of overconstraint. Although several laboratory studies report overconstraint with iliotibial band based procedures, clinical reports of overconstraint are rare. This may be due to lack of a clear definition of clinical overconstraint and resultant underdiagnosis. However, long term randomised controlled study has demonstrated significantly higher rates of osteoarthritis when a modified Lemaire is added to an anterior cruciate ligament reconstruction. There is clearly a need for further study and in the meantime clinical efficacy must be balanced with the risk of kinematic restriction.