Anterolateral complex of the knee: State of the art

Table 1 Indications for an extra-articular procedure

Patients with specific characteristics:
ACL revisions
Chronic ACL injuries
High-grade pivot shifts
Segond’s fracture
Hyperlaxity
High demanding patients

ACL: Anterior cruciate ligament.

Table 2 The most performed lateral extra-articular tenodesis

Technique	Description
Lemaire et al[87], 1967	An ITB strip is harvested while maintaining the distal insertion, and then passed under the FCL and through a semi-circular tunnel created on the lateral aspect of the distal femur. The strip is then reflected and sutured onto itself.
Mod. Lemaire[21,88,89]	An ITB strip is harvested while maintaining the distal insertion, passed under the FCL, and secured to the lateral condyle with an interference screw or a staple.
MacIntosh et al[90], 1976	An ITB strip is harvested while maintaining the distal insertion, passed under the FCL, through a subperiosteal tunnel, through the intermuscular septum, back under the FCL, and sutured onto itself.
Losee et al[91], 1978	An ITB strip is harvested while maintaining the distal insertion, passed under the FCL, through a femoral tunnel originating at the gastrocnemius insertion point and ending anterior to the FCL. The strip is then sutured onto itself.
Ellison et al[92], 1979	A strip of ITB is elevated distally with a bony bract, passed under the FCL, and attached anteriorly to the original insertion.
Arnold and Coker et al[62], 1979	An ITB strip is harvested while maintaining the distal insertion, passed under the FCL, reflected, and sutured to itself at Gerdy’s tubercle.
Benum[93], 1982	A lateral portion of the patellar tendon is harvested while maintaining the distal insertion, passed under the FCL, and secured with a staple to the lateral condyle.
Andrews and Sanders[94], 1983	Two ITB strips are elevated proximally, whipstitched with sutures that are passed through two parallel tunnels from the lateral condyle to the medial condyle, and then tied together.
Zarins and Rowe[95], 1986	The semitendinosus tendon is harvested while maintaining the insertion, passed through a tibial tunnel, through the joint, and over the lateral condyle below the FCL ,and sutured to the ITB. Similarly, a strip of ITB is harvested proximally, passed under the FCL, over the lateral condyle, through the tibial tunnel, and sutured to the semitendinosus tendon.
Wilson and Scranton[96], 1990	An ITB strip is harvested while maintaining the distal insertion, passed under the FCL and lateral gastrocnemius tendon, and sutured onto itself.
Marcacci and Zaffagnini[97], 1998	The semitendinosus and gracilis tendons are harvested while maintaining the insertion, sutured together, passed through a tibial tunnel, through the femoral notch, and over the top of the lateral condyle. The graft is then passed deep to the ITB, over the FCL, and attached distally to Gerdy's tubercle.

FCL: Fibular collateral ligament; ITB: Iliotibial band.