Lateral tenodesis

Do I need a lateral tenodesis for my torn anterior cruciate ligament?

Why does a newly reconstructed cruciate ligament tear again?

While anterior cruciate ligament (ACL) reconstruction is a successful surgery, a significant percentage of patients experience a re-tear of their new ligament. There are many different reasons for this, often related to persistent instability, technical issues with the previous surgery, or another knee injury.

The ACL stabilizes the knee in two ways:

  • Anterior-posterior stability: The ACL prevents the shinbone from moving forward relative to the thighbone.
  • Rotational stability: The ACL prevents the shinbone from rotating inward relative to the thighbone.

Rotational stability is not solely provided by the ACL but also by other ligaments and structures on the outside of the knee. These include the iliotibial band, Kaplan fibers, and anterolateral ligament.

In addition to these ligaments on the outside of the knee, factors specific to the patient should also be considered as they can increase the risk of ACL reconstruction re-tear. These factors may include hypermobility, knee hyperextension, gender, and age.

Over the years, numerous scientific studies have highlighted the importance of considering all these factors in the surgical decision-making process for performing the operation. Ultimately, all these factors can contribute to the premature re-tear of your new ligament.

What is an ALL reconstruction or a lateral tenodesis?

The role of structures on the outside of the knee in relation to anterior cruciate ligament (ACL) tears is becoming increasingly clearer and more important to address. In recent years, there has been a particular focus on the role of the anterolateral ligament (ALL). This ligament is often affected when the ACL is torn.

The anterolateral ligament (ALL) is located on the outside of the knee and connects the femur (thighbone) to the tibia (shinbone).

Many studies have shown the importance of addressing the anterolateral ligament (ALL) or reinforcing the lateral side of the knee in addition to ACL reconstruction. This can be achieved through ALL reconstruction or lateral tenodesis (also known as Lemaire plastiek). In a lateral tenodesis, a strip of tissue (approximately 1 cm thick and 8-10 cm long) is taken from the iliotibial band on the outside of the knee and passed underneath the lateral collateral ligament. It is then secured to the femur, creating a connection between the femur and tibia. This reinforces the rotational stability, reducing the risk of ACL re-tear by 70%.
laterale tenodese

The lateral tenodesis involves taking a portion of the iliotibial tract under the lateral collateral ligament and securing it to the femur.

all reconstructie

The ALL reconstruction involves attaching a graft, which can also be made of synthetic material, with two screws at the original location of the anterolateral ligament.

Is there scientific evidence for lateral tenodesis?

Yes, recent well-conducted scientific research has shown that lateral tenodesis reduces the risk of re-tearing the anterior cruciate ligament in young patients who have undergone ACL reconstruction. The rate of ACL reconstruction re-tears decreased by 70%, from 11% to 4%.

Are there any drawbacks to lateral tenodesis?

With lateral tenodesis, the scar on the outside of the knee is enlarged. It will be approximately 3 to 4 cm long. In the first 6 weeks after the surgery, there may be slightly more pain on the outside of the knee. However, four months after the surgery, there should be no difference compared to an ACL operation without a lateral tenodesis.

Indications for lateral tenodesis

Not everyone requires this surgery, and it is primarily recommended for patients who are at a high risk of re-tearing their anterior cruciate ligament (ACL):


  • Patients with hyperlaxity/hypermobility
  • Patients younger than 30 years old
  • Revisions of previously performed ACL reconstruction
  • Elite athletes participating in cutting and pivoting sports such as football, hockey, tennis, and handball


Lateral tenodesis is a surgical procedure performed during ACL reconstruction that enhances the rotational stability of the knee. It has been demonstrated to reduce the risk of re-tearing your new anterior cruciate ligament by 70%.

Contact us

If you have a torn anterior cruciate ligament and want to know if a lateral tenodesis should be performed in addition to replacing your ligament, please contact us.