The goal of lateral extra-articular augmentation or reconstruction is to eliminate residual laxity and reduce the risk of ACL graft rupture. Two common techniques include iliotibial band (ITB) tenodesis and anterolateral ligament (ALL) reconstruction. These procedures play a role in augmenting rotational stability in the ACL-reconstructed knee. Patients who see the greatest benefit include hyperlax patients, revision cases, pivoting athletes, and those with IKDC grade III pivot shifts.

There are several distinct advantages of using adjustable, tensionable implant technology, such as the Knotless FiberTak® or FiberTag® TightRope®, when compared to traditional techniques using staples or interference screws. These advantages include:

  • Simple: Quick, easy, and reproducible techniques.
  • Safe: Reduced risk of ACL femoral tunnel convergence as Knotless FiberTak anchor sets just below the cortex. The self-punching anchor technique is designed to reduce the risk of damaging ACL graft as seen with traditional techniques that require drilling. No risk of graft laceration as described with interference screw techniques.1
  • Low Profile: Techniques using additional hardware, such as staples, may lead to pain or discomfort, warranting hardware removal. There is no prominent hardware when using an anchor or TightRope implant.1
  • Preserves Anatomy: The Knotless FiberTak onlay technique avoids drilling a socket. The FiberTag TightRope Implant  minimizes the length of graft required for harvest.
  • Titratable Graft Tensioning: With these techniques, a surgeon can provisionally tension and incrementally retension the graft after checking for isometry and overconstraint



1. Muller B, Willinge GJA, Zijl JAC. Minimally invasive modified Lemaire tenodesis. Arthrosc Tech. 2020;10(1):e29- e36. doi:10.1016/j.eats.2020.09.006

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