Consent✅ ACL reconstuction with lateral tenodesis 9 months ago Persistent lateral pain 'sliding / catching' sensation over tenodesis site on predictable knee flexion squat angle Tenodesis screw looks ok on x-ray POCUS - fluid / inflammation seen around graft as passes under LCL (graft = circle.... then narrow slip... as US turns longitudinal) @orthotwitter - do you see graft / tenodesis soft tissue irritation - impingement? - in any of your cases?show more

Lots of different techniques, but crudely to correlate with US....

I haven't yet, but I can see how it could. When we pass the graft deep to the LCL, we need to open up a decent-sized channel anterior and posterior to the LCL; otherwise, the graft cannot slide properly with flexion. If you do not open up this channel, the graft will hang up on the capsule.

Interesting thanks Howard

Interestingly the suture material sits quite 'proud' on the MRI coronal, but pain isn't in this location

I’ve not seen this but as these lateral augmentations become more common so will the issues that arise. I’m not saying they’re a bad thing, they’re often helpful, but there’s no such thing as a free lunch.

I’ve not seen this much via knee clinics James but my partner had her endobutton removed for same reason, seems to have worked 👍

Ah thanks James! So seems like the 'pathology' is out there

Knock on wood… I have not. Another pleasantly surprising fact is they don’t seem to have any additional struggles with post op ROM like you might expect with the addition of an extraarticular procedure. I am doing more and more LETs and have been very happy

I see a significant tunnel widening at the femur, only 9m po. Allograft? It seems as well that the tibial tunnel partially perforates the medial plateau (or that might be incidential). Do you have an MRI?

Mri looks ok