Named lateral extra-articular tenodesis technique routing IT band over the LCL.
The MacIntosh procedure is a lateral extra-articular tenodesis (LET) technique in which a strip of iliotibial band is harvested, left attached distally, and rerouted superficial to the lateral collateral ligament before being fixed to the lateral femoral condyle. This superficial-to-LCL routing is the key technical feature that distinguishes it from the Lemaire variant, which passes the graft deep to the LCL. It is not a standalone procedure but an adjunct performed alongside ACL reconstruction.
For clinicians managing post-operative rehab or counselling patients pre-operatively, knowing whether a MacIntosh (or Lemaire) LET was added to the ACL reconstruction changes expectations around rotational control, particularly in young, high-risk, or revision patients where graft failure and pivot-shift recurrence are bigger concerns. It also flags a slightly different lateral-sided surgical footprint and loading pattern to consider when planning early-phase exercise and monitoring for lateral-sided irritation.
In practice this is applied intraoperatively by the surgeon and documented in the operative report; clinicians encounter it through the surgical note or discharge summary rather than by testing for it directly. Post-operatively, its presence is inferred from the incision pattern and rehab protocol, and its functional effect is monitored indirectly via reduced pivot-shift grade and rotational stability on clinical exam compared to isolated ACL reconstruction.
Evidence for added benefit of LET techniques including MacIntosh is strongest in specific high-risk subgroups (e.g. high-grade pivot shift, young athletes, revision cases), so its presence doesn't automatically mean a more aggressive or accelerated rehab is appropriate. Superficial versus deep LCL routing (MacIntosh vs Lemaire) is a technical distinction with limited direct comparative clinical outcome data, so clinicians should avoid assuming one variant confers a clear functional advantage over the other based on routing alone.
This guide was auto-drafted and is pending editorial review.