Lateral Extra-articular Tenodesis in ACL Reconstruction


Lateral extra-articular tenodesis (LEAT) has been utilized as an adjunct to primary anterior cruciate ligament (ACL) reconstruction to try to improve rotational stability. However, its efficacy and indications remain controversial.

Surgical Techniques

LEAT involves an extra-articular graft to reinforce the anterolateral structures. Common techniques include iliotibial band tenodeses such as the Lemaire, Losee, and MacIntosh procedures. The graft is often attached to the lateral femoral condyle.

Pivot Shift Outcomes

A recent systematic review found LEAT significantly reduced pivot shift versus ACL reconstruction alone in patients undergoing delayed surgery (>12 months from injury).1 However, LEAT did not reduce pivot shift in early reconstructions within 12 months.

Other Outcomes

There was insufficient evidence that LEAT provided additional improvement in Lachman testing, KT arthrometry, strength, functional scores, return to sport, or complications compared to ACL reconstruction alone.1


Current evidence suggests the benefit of LEAT in reducing rotational instability is limited to patients with chronic ACL deficiency undergoing delayed reconstruction. For early primary ACL tears, LEAT does not appear to improve pivot shift. Further study is needed to determine impacts on patient-reported outcomes.

In summary, selective use of LEAT may be warranted for managing rotational instability in delayed ACL reconstruction but routine use in early ACL surgery is not supported. Surgeons should consider individuals’ degree of instability and time from injury when weighing LEAT.


1. Devitt BM, Bell SW, Ardern CL, et al. The role of lateral extra-articular tenodesis in primary anterior cruciate ligament reconstruction: a systematic review with meta-analysis and best-evidence synthesis. Orthop J Sports Med. 2017;5(10):2325967117731767.

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