Discover what lateral extra-articular tenodesis is, based on Marcel Lemaire's surgical technique and its modern applications.
First and foremost, what is lateral extra-articular tenodesis? Lateral extra-articular tenodesis (LEAT) is a surgical technique designed to enhance rotational stability of the knee, particularly in patients undergoing anterior cruciate ligament (ACL) reconstruction.
This article is based entirely on the study "A review of Marcel Lemaire's original work on lateral extra-articular tenodesis" led by Prof. Cavaignac, Timothy McAleese, Jérôme Murgier and Brian M. Devitt and published in the Journal of ISAKOS, 2024.
For a deeper understanding of this and other advanced techniques, we invite you to explore further clinical studies published by Professor Cavaignac, a leading specialist in ACL and multiligament knee surgery.
The lateral extra-articular tenodesis procedure was originally described by Marcel Lemaire in 1967, a time when the role of the ACL in knee stability was still poorly understood. Lemaire proposed a novel way to counteract persistent rotational instability in ACL-deficient knees by creating a “neo-ligament” using a nylon cord placed superficial to the lateral collateral ligament (LCL).
The lateral extra-articular tenodesis technique is aimed to limit the internal rotation of the tibia, a key factor in the pivot shift phenomenon. Over time, the method evolved into what is now known as the "modified Lemaire technique," which remains one of the most widely used forms of ACL lateral extra-articular tenodesis in modern knee surgery.
Today, ACL reconstruction with lateral extra-articular tenodesis is often recommended in high-risk individuals, such as athletes or patients with generalised ligamentous laxity, who are more susceptible to graft failure. Lemaire’s findings confirmed that addressing rotational laxity (pivot shift) rather than anterior translation alone was critical for restoring full function.
Recent studies like the STABILITY trials have shown that adding LEAT to ACL reconstruction significantly reduces graft failure rates without increasing complications, validating Lemaire’s early conclusions.
The lateral extra-articular tenodesis knee surgery technique has been refined over decades, but key principles remain consistent. Initially, Lemaire used a strip of fascia lata or nylon cord, passing it across the lateral aspect of the knee, superficial or deep to the LCL and anchoring it at Gerdy’s tubercle and the lateral femoral condyle.
Over time, this was adapted to allow passage through bone tunnels and to include different fixation methods such as staples or screws. The positioning of the graft is crucial: too anterior and it restricts flexion; too posterior and it may impair deep flexion or create excess tension. The original method also required a month-long immobilisation, but more recent adaptations allow for earlier mobilisation and integration into ACL rehab protocols.
While generally safe, lateral extra-articular tenodesis complications may include overconstraint of the knee, irritation at the graft site or limited flexion. These risks are typically mitigated with modern fixation techniques and careful graft placement. Lemaire himself adjusted his method across over 2000 cases, introducing modifications that improved graft tensioning and reduced healing time.
A structured lateral extra-articular tenodesis rehab protocol mirrors the timeline of standard ACL rehabilitation but often includes a slightly delayed return to pivot-heavy activities to ensure proper integration of the lateral graft.
Typical lateral extra-articular tenodesis recovery includes:
Scar management is also crucial. Although the lateral extra-articular tenodesis scar is generally well tolerated, attention should be given to its placement and tension to avoid hypertrophy or adhesions.
Digital support and follow-up
Tools like Orthense, as used in Professor Cavaignac’s practice, offer digital monitoring throughout the post-operative phase to ensure adherence to the protocol and early detection of complications.
The renewed interest in extra-articular lateral tenodesis, especially through the modified Lemaire approach, highlights its enduring relevance in managing rotatory knee instability.
If you are considering surgery, trust in Professor Etienne Cavaignac’s expertise for a precise diagnosis, expert intervention and structured rehabilitation.
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