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. 2025 Apr:11:100393.
doi: 10.1016/j.jisako.2025.100393. Epub 2025 Feb 3.

When is anterolateral complex augmentation indicated? Perspectives from the 2024 Freddie Fu Panther Sports Medicine Symposium

Joseph D Giusto  1 , Efstathios Konstantinou  2 , Stephen J Rabuck  2 , Bryson P Lesniak  2 , Jonathan D Hughes  2 , James J Irrgang  3 , Volker Musahl  2 ; Panther ACL Treatment Group
Collaborators, Affiliations
Free article

When is anterolateral complex augmentation indicated? Perspectives from the 2024 Freddie Fu Panther Sports Medicine Symposium

Joseph D Giusto et al. J ISAKOS. 2025 Apr.
Free article

Abstract

Purpose: This study aimed to determine the trends and indications for anterolateral complex augmentation during anterior cruciate ligament reconstruction (ACL-R) among international orthopedic sports surgeons.

Methods: An electronically distributed survey was sent out to international surgeons with high-volume experience in complex ligament reconstructions and revision surgery attending the 2024 Freddie Fu Panther Sports Medicine Symposium. The survey was sent prior to the meeting with questions related to the use of lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALL-R) during ACL-R. Sessions pertaining to anterolateral complex augmentation were held during the symposium to inform about current clinical practices among attendees.

Results: A total of 49 surgeons were identified from 5 different geographic regions prior to the meeting date and were sent an electronic survey, of which 48 responded (98% response rate). Among the surgeons who reported performing anterolateral complex augmentation procedures (n = 45), a total of 39 (87%) respondents reported using only the LET technique, 2 (4%) reported using only the ALL-R technique, and 4 (9%) reported using both techniques during ACL-R. The most common indication for anterolateral complex augmentation was a high-grade pivot shift, which 39 of 43 (91%) respondents ranked in their top 3 indications. In the setting of primary ACL-R, respondents added LET when using hamstring tendon autograft in 38% of cases on average compared with 34% of cases when using either bone-patellar tendon-bone autograft or quadriceps tendon autograft. In the setting of revision ACL-R, LET was added in an average of 68% of cases for a first-time revision ACL-R and in 84% of cases for a multiple-revision ACL-R.

Conclusion: The most common indication for ACL-R with anterolateral complex augmentation was a high-grade pivot shift and most respondents preferred LET over ALL-R. Respondents performed LET in a comparable percentage of cases of primary ACL-R using hamstring tendon, bone-patellar tendon-bone, and quadriceps tendon autografts, and this number increased with the number of revision ACL-Rs. Based on the results of this survey, surgeons may consider adding LET in cases of revision ACL-R or in patients with a high-grade pivot shift.

Level of evidence: Level V.

Keywords: ACL; Anterolateral ligament reconstruction; Lateral extra-articular tenodesis; Revision surgery; Rotatory instability.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bryson P. Lesniak received payment from Mid-Atlantic Surgical Systems for education. Jonathan D. Hughes has received grant support from Arthrex, education payments from Mid-Atlantic Surgical Systems and Smith + Nephew, and hospitality payments from SI-BONE and Stryker and is on the editorial board of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). James J. Irrgang is President of the Board of Directors for the Journal of Orthopaedic and Sports Physical Therapy (JOSPT). Volker Musahl received consulting fees from Smith & Nephew and Newclip, educational fees from Arthrex, DePuy Synthesis, and Conmed, and is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), and the Assistant editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). Volker Musahl has a patent, U.S. Patent No. 9,949,684, issued on April 24, 2018, to the University of Pittsburgh. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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