Simultaneous Backup Femoral-sided Anterior Cruciate Ligament Graft Fixation and Lateral Extra-Articular Tenodesis With Iliotibial Band Anchoring With Single-Suture Anchor

The modified Lemaire lateral extra-articular tenodesis (LET) has gained increasing adoption as an augmentation technique for high-risk primary and revision anterior cruciate ligament (ACL) reconstructions. Recent studies show lower rates of ACL graft failure and rotatory laxity when LET is combined with ACL reconstruction. In revision ACL surgery, optimal graft fixation becomes especially critical because compromised bone stock from previous surgeries increases the risk of fixation failure attributable to device failure, bone osteopenia, suboptimal tunnel placement, or inadequate tendon-bone interface. To address these challenges, backup femoral fixation methods using suture anchors are employed to reinforce primary fixation. This Technical Note presents a technique for backup fixation of ACL graft combined with LET anchoring through a single suture anchor. This approach offers several advantages including dual fixation capability through a single anchor, compatibility with various primary fixation methods, and enhanced stability in cases with decreased bone quality or suboptimal tunnel positioning.