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The anterior cruciate ligament (ACL) is a key fibrous connective tissue in the centre of the human knee. When stretched or torn, this ligament jeopardises knee stability and strength. Even after surgery, the ACL can tear again, especially in active individuals. Approximately 5-15% of patients with an ACL reconstruction tear their ligaments again after returning to sports or other physical activities.

ACL tears are one of the most common orthopaedic knee injuries. However, medical procedures do not always prevent further knee damage. Studies are also highlighting that female athletes are more vulnerable to ACL tears. These revelations suggest that orthopaedic surgeons should implement additional measures to protect certain patients from repeat injuries. Kash Akhtar, a Consultant Orthopaedic Knee Surgeon and Associate Professor at Barts and Cleveland Clinic London, asserts that the Lateral Extra-articular Tenodesis (LET) procedure may address this alarming trend.

Orthopaedic Surgeon Reveals The 10-Minute Operation That Could Save Your
Orthopaedic Surgeon Reveals The 10-Minute Operation That Could Save Your ACL Graft Pixabay

The LET procedure occurs on the outside of the knee joint during an ACL reconstruction. As surgeons repair a torn ACL, they will take additional steps to reinforce the ACL graft. This reduces force on the new ACL and protects it during twisting activities such as soccer, tennis, padel, and skiing. As a result, patients are less likely to re-tear the ligament.

Although LET has only recently gained popularity in major orthopaedic circles, it isn't a new procedure. Created decades ago as the original treatment for ACL injuries before the advent of keyhole surgery, this practice has saved millions from the pain and burden of re-injury. When the ACL is torn, it causes severe pain and swelling and is unlikely to heal without surgery. For professional athletes, this injury is devastating both for their physical health and their career. Reports show that ACL injuries are increasingly common among female football players.

Women are two to eight times more likely than their male counterparts to tear their ACL due to several factors. In the last 10 years, ACL injuries have also increased 300% among adolescents, highlighting the need for greater public awareness about prevention methods and medical procedures.

Kash notes that surgeons should determine whether a LET procedure is suitable for a patient on a case-by-case basis. However, younger patients, those wanting to return to high-level twisting sports, those with a family history of ACL injuries, professional athletes, and those with joint hypermobility will find great benefits from the surgery. Additionally, patients who have torn a previously reconstructed ACL and are being operated on for the second time are especially in need of the LET procedure. "The LET procedure has a low-risk profile and usually takes 10 minutes or less to complete," Kash says. "Research shows that LET can reduce reinjury rates significantly, making it worthwhile for patients and their practitioners to investigate this surgery."

One of the most prominent clinical trials detailing the success of the LET procedure on ACL reconstruction patients was performed in multiple countries and underlines this finding. Two-year outcomes show that out of 618 patients, those who didn't receive the LET procedure were twice as likely to experience re-tearing. Other studies have expanded on LET's ability to improve graft stability and patient quality of life.

Kash, who has been a practising medical doctor for over two decades and a specialist consultant from 2014 onwards, believes that this procedure will only grow in popularity, as patients and surgeons increasingly see the benefits. However, he strongly believes that surgery should only be a final resort for patients after a thorough period of prehabilitation. From his experience working in the UK's most prestigious hospitals, many strategies can be used to prevent injury in the first place. He advocates for youth athletes in particular to receive this education as it's pivotal for their long-term health. Kash offers his insights on sports injuries and orthopaedics as a high-profile educator and a doctor with vast experience in treating sports knee injuries. Kash's passion for medicine stems from his desire to empower people to regain the capability to be active, with a mission to improve mobility and enhance lives.