Not all ACL injuries are the same and some will have additional damage to other structures that normally assist the ACL in making the knee stable. The combination and severity of these secondary injuries can vary, and they may or may not heal. The combined outcome of these injuries will contribute to the degree of instability within the knee, and the pivot shift is the best clinical test for this. The addition of an anterolateral tenodesis to an ACL reconstruction may be required when the effect of additional injuries, on their own or in combination, results in a well performed ACL reconstruction being unable to stabilise the knee. In these situations the author found that adding the “modified ITB tenodesis” was able to restore complete stability to the knee and hence incomplete correction of the pivot shift at the time of surgery is an appropriate indication to add this procedure.
Click on the link below to read the paper published in the Am J Sport Med 2026