LETS - Lateral Extra-articular Tenodesis

Procedure

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LETS Procedure is often performed in addition to the ACL reconstruction to provide further stability to the knee in the antero-lateral direction. It is not required in every patient undergoing the ACL reconstruction, however a small percentage of people with subtle instability even after the ACL reconstruction may need LETS procedure. This decision often has to be taken by the operating surgeon in the OT. 

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ACL Reconstruction

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ACL surgery is performed in the standard fashion by using one of the autografts (Hamstrings / Peroneus longus / Quads tendon / Bone Tendon Bone). The ACL graft fixation is either by using the Tightrope Button and Bioscrew or Tightrope Button fixation on both the sides of the ligament. Post the secure fixation of the ACL, joint is assessed clinically on the table for stability using 3 different clinical tests. On examining, if there is subtle laxity in certain angles then we proceed with the LETs procedure. In patients where revision ACL surgery is being performed LETs is done routinely to give extra stability. 

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LETS Procedure 

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LETS or lateral extra-articular tenodesis is an open procedure and not through arthroscopy. A 3 to 4 cm incision over the outer side of the knee is needed. A part of the IT band is separated from the proximal end while leaving its distal attachment to the leg bone intact. The proximal end is then passed under the LCL (Lateral Collateral Ligament) and brought upto just proximal to the bone prominence on the outer side of the knee (Lateral epicondyle) and fixed to the bone by using a suture anchor (PEEK or Bio material based). ​

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ACL + LETs Rehabilitation

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ACL Rehab starts from the day 1. Rehabilitation for ACL + LETs is no different from the standard rehab protocol post ACL Reconstruction alone. Post-surgery, you are allowed to walk on the same day evening. If your meniscus is intact and only ACL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg. Initial one week you may need the support of a walker. Within a week most people manage to walk without support. Physiotherapy exercises are started early. In the first 6 weeks the focus is mainly on getting the full range of movement and help regain the muscle strength. The whole rehabilitation process will take about 6 to 8 months before returning back to playing sports on the ground or court. ​

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