Residual rotational instability remains a challenge after ACL reconstruction. At PCO 2026, Brian Devitt presented a modified Ellison procedure combined with ACL reconstruction to improve anterolateral stability. This simple lateral extra-articular tenodesis procedure may be particularly useful in paediatric and adolescent patients, where preserving the physis and avoiding tunnel convergence are important considerations.
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What is the modified Ellison procedure?
Originally described as an isolated extra-articular procedure, the Ellison lateral extra-articular tenodesis technique involves a distally based iliotibial band (ITB) tenodesis. The modified version presented by Brian Devitt is performed in combination with ACL reconstruction and focuses on restoring rotational control without requiring additional femoral tunnels.
Key surgical steps include:
- Harvesting a 1 cm strip of the iliotibial band attached distally at Gerdy's tubercle
- Passing the graft beneath the lateral collateral ligament
- Reattaching it using a knotless anchor
- Completing ACL fixation after the LET procedure
What are the key benefits of the modified Ellison procedure?
- Combines ACL reconstruction with lateral extra-articular tenodesis (LET).
- Helps control residual anterolateral rotational laxity.
- Uses a simple, reproducible lateral extra-articular tenodesis procedure.
- Avoids additional femoral tunnel creation.
- Particularly suited to paediatric and adolescent ACL reconstruction.
- May reduce concerns related to physeal injury and tibial tunnel convergence.
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