Role of lateral extra-articular tenodesis (LET) in anterior cruciate ligament-injured athletes.

Lateral extra-articular tenodesis (LET) has re-emerged as a significant adjunct to anterior cruciate ligament reconstruction (ACLR), particularly in high-level athletes who are at a heightened risk for re-injury and graft failure. This review synthesizes recent literature examining the biomechanical and clinical outcomes associated with LET in the context of ACLR in high-level athletes. Biomechanical studies indicate that LET can enhance knee stability by providing additional restraint against anterior tibial translation and rotatory instability, thereby reducing rotational laxity and offloading stress on the intra-articular graft. Cadaveric and in vivo studies suggest that LET can reduce forces applied to the graft and improve knee kinematics, particularly in the setting of concomitant injury to the anterolateral complex. Furthermore, recent clinical research has shown that incorporating LET during ACLR surgery is associated with lower rates of graft failure and improved functional outcomes, including high rates of return to pre-injury level of sport among high-level athletes. However, the literature also highlights the need for careful patient selection and consideration of potential implant-related complications, as well as the risk of lateral knee pain. Recent evidence indicates that LET does not increase the risk of lateral compartment osteoarthritis when modern surgical techniques and appropriate graft tensioning are employed. Overall, while LET shows promise in improving the outcomes of ACLR surgery in high-level athletes, further high-quality research is warranted to establish standardized protocols and long-term efficacy.