Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique?
<h3 dir="ltr">Purpose of review</h3><p dir="ltr">To provide a comprehensive overview of the indications for lateral extra-articular tenodesis in addition to anterior cruciate ligament reconstruction (ACLR), followed by a discussion on the existing techniques wit...
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| المؤلف الرئيسي: | |
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| مؤلفون آخرون: | , , |
| منشور في: |
2026
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| _version_ | 1864513522132582400 |
|---|---|
| author | Enejd Veizi (23653423) |
| author2 | Lucy Oliver-Welsh (23670777) Christos Koutserimpas (23670780) Emrah Imat (23670785) |
| author2_role | author author author |
| author_facet | Enejd Veizi (23653423) Lucy Oliver-Welsh (23670777) Christos Koutserimpas (23670780) Emrah Imat (23670785) |
| author_role | author |
| dc.creator.none.fl_str_mv | Enejd Veizi (23653423) Lucy Oliver-Welsh (23670777) Christos Koutserimpas (23670780) Emrah Imat (23670785) |
| dc.date.none.fl_str_mv | 2026-04-02T21:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1007/s12178-026-10028-9 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Extra-articular_Tenodesis_for_ACL_Reconstruction_Who_Needs_it_and_is_there_a_Superior_Technique_/31923018 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Clinical sciences Health sciences Sports science and exercise Lateral extra-articular tenodesis anterior cruciate ligament (ACL) injury Anterolateral complex Ligament reconstruction Arthroscopy Knee |
| dc.title.none.fl_str_mv | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3 dir="ltr">Purpose of review</h3><p dir="ltr">To provide a comprehensive overview of the indications for lateral extra-articular tenodesis in addition to anterior cruciate ligament reconstruction (ACLR), followed by a discussion on the existing techniques with their perceived advantages and disadvantages.</p><h3 dir="ltr">Recent findings</h3><p dir="ltr">Recent evidence has shifted lateral extra-articular tenodesis (LET) from a routine “add-on” to a selective adjunct for patients at higher risk of residual rotatory instability and ACL graft failure after isolated ACLR. Level I clinical evidence suggests that adding an iliotibial (ITB) – based LET can meaningfully reduce graft rupture rates while improving control of pivot shift – type instability. The 2025 International Consensus on lateral extra-articular procedures (LEAPs) supports LET/anterolateral augmentation particularly for revision ACLR, high-grade pivot shift, generalized laxity or hyperextension/recurvatum, and young athletes returning to pivoting/contact sports. The consensus also mentions that modern LEAPs have low complication rates, do not typically require altered rehabilitation, and have not shown a consistent signal for increased lateral compartment osteoarthritis when contemporary technique principles are followed. Finally, despite the variety of described constructs (modified Lemaire variants, other ITB-based tenodeses, and anatomic ALL reconstruction), current literature does not demonstrate a single universally superior technique. Instead, success appears to be linked to correct patient selection, adherence to key technical principles (appropriate graft routing & low-tension fixation), and age or skeletal – maturity – appropriate modifications.</p><h3 dir="ltr">Summary</h3><p dir="ltr">When applied selectively in high-risk patients, adding a lateral extra-articular tenodesis to ACL reconstruction can improve rotational control and reduce re-injury, but current evidence does not support a single universally superior LET construct. Optimal results depend on appropriate indications, careful technique, and tailoring the approach to patient factors such as age, sport demands, laxity profile, and skeletal maturity.</p><h2 dir="ltr">Other Information</h2><p dir="ltr">Published in: Current Reviews in Musculoskeletal Medicine<br>License: <a href="https://creativecommons.org/licenses/by/4.0" rel="noopener noreferrer" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1007/s12178-026-10028-9" rel="noreferrer" target="_blank">https://dx.doi.org/10.1007/s12178-026-10028-9</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_f7b77c4a804ce1aa6aaf164873832669 |
| identifier_str_mv | 10.1007/s12178-026-10028-9 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/31923018 |
| publishDate | 2026 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique?Enejd Veizi (23653423)Lucy Oliver-Welsh (23670777)Christos Koutserimpas (23670780)Emrah Imat (23670785)Biomedical and clinical sciencesClinical sciencesHealth sciencesSports science and exerciseLateral extra-articular tenodesisanterior cruciate ligament (ACL) injuryAnterolateral complexLigament reconstructionArthroscopyKnee<h3 dir="ltr">Purpose of review</h3><p dir="ltr">To provide a comprehensive overview of the indications for lateral extra-articular tenodesis in addition to anterior cruciate ligament reconstruction (ACLR), followed by a discussion on the existing techniques with their perceived advantages and disadvantages.</p><h3 dir="ltr">Recent findings</h3><p dir="ltr">Recent evidence has shifted lateral extra-articular tenodesis (LET) from a routine “add-on” to a selective adjunct for patients at higher risk of residual rotatory instability and ACL graft failure after isolated ACLR. Level I clinical evidence suggests that adding an iliotibial (ITB) – based LET can meaningfully reduce graft rupture rates while improving control of pivot shift – type instability. The 2025 International Consensus on lateral extra-articular procedures (LEAPs) supports LET/anterolateral augmentation particularly for revision ACLR, high-grade pivot shift, generalized laxity or hyperextension/recurvatum, and young athletes returning to pivoting/contact sports. The consensus also mentions that modern LEAPs have low complication rates, do not typically require altered rehabilitation, and have not shown a consistent signal for increased lateral compartment osteoarthritis when contemporary technique principles are followed. Finally, despite the variety of described constructs (modified Lemaire variants, other ITB-based tenodeses, and anatomic ALL reconstruction), current literature does not demonstrate a single universally superior technique. Instead, success appears to be linked to correct patient selection, adherence to key technical principles (appropriate graft routing & low-tension fixation), and age or skeletal – maturity – appropriate modifications.</p><h3 dir="ltr">Summary</h3><p dir="ltr">When applied selectively in high-risk patients, adding a lateral extra-articular tenodesis to ACL reconstruction can improve rotational control and reduce re-injury, but current evidence does not support a single universally superior LET construct. Optimal results depend on appropriate indications, careful technique, and tailoring the approach to patient factors such as age, sport demands, laxity profile, and skeletal maturity.</p><h2 dir="ltr">Other Information</h2><p dir="ltr">Published in: Current Reviews in Musculoskeletal Medicine<br>License: <a href="https://creativecommons.org/licenses/by/4.0" rel="noopener noreferrer" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1007/s12178-026-10028-9" rel="noreferrer" target="_blank">https://dx.doi.org/10.1007/s12178-026-10028-9</a></p>2026-04-02T21:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1007/s12178-026-10028-9https://figshare.com/articles/journal_contribution/Extra-articular_Tenodesis_for_ACL_Reconstruction_Who_Needs_it_and_is_there_a_Superior_Technique_/31923018CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/319230182026-04-02T21:00:00Z |
| spellingShingle | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? Enejd Veizi (23653423) Biomedical and clinical sciences Clinical sciences Health sciences Sports science and exercise Lateral extra-articular tenodesis anterior cruciate ligament (ACL) injury Anterolateral complex Ligament reconstruction Arthroscopy Knee |
| status_str | publishedVersion |
| title | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| title_full | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| title_fullStr | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| title_full_unstemmed | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| title_short | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| title_sort | Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? |
| topic | Biomedical and clinical sciences Clinical sciences Health sciences Sports science and exercise Lateral extra-articular tenodesis anterior cruciate ligament (ACL) injury Anterolateral complex Ligament reconstruction Arthroscopy Knee |