Role of Lateral Extra-Articular Tenodesis in Anterior Cruciate Ligament Reconstruction Outcomes: A Comparative Clinical Study

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) restores anteroposterior knee stability in most patients; however, residual anterolateral rotatory instability and graft failure remain clinically important, particularly among young individuals returning to pivoting sports. Lateral extra-articular tenodesis (LET) has re-emerged as an adjunct to ACLR to improve rotational control and decrease mechanical loading of the intra-articular graft. The present study evaluated the influence of LET augmentation on stability, graft survival, functional outcomes, and return to sport after primary ACL reconstruction.

Methods: A prospective comparative study included 160 patients undergoing primary arthroscopic ACLR. Eighty patients underwent isolated ACLR and 80 underwent ACLR combined with modified Lemaire LET. Patients were evaluated preoperatively and followed for 24 months. Primary outcomes were graft failure and residual pivot shift. Secondary outcomes included KT-1000 side-to-side anterior translation, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Knee injury and Osteoarthritis Outcome Score-Sport/Recreation (KOOS-Sport), Tegner activity level, return to preinjury sport, and postoperative complications. Continuous and categorical variables were analyzed using appropriate parametric/nonparametric and chi-square or Fisher exact tests, respectively.

Results: The two groups were comparable at baseline. Graft failure occurred in 10/80 patients (12.5%) after isolated ACLR compared with 2/80 (2.5%) after ACLR+LET (p=0.032). Residual positive pivot shift occurred in 22.5% versus 6.3%, respectively (p=0.006). KT-1000 side-to-side translation was significantly lower following LET augmentation (1.8±1.1 vs 2.7±1.3 mm; p<0.001). Final IKDC (90.5±7.6 vs 88.4±8.2; p=0.095), Lysholm (92.4±6.7 vs 90.6±7.4; p=0.109), and return-to-preinjury-sport rates (71.3% vs 65.0%; p=0.498) were comparable.

Conclusion: Addition of LET to ACL reconstruction was associated with superior rotational stability and markedly reduced graft failure without compromising functional recovery. The principal clinical advantage of LET appeared to be graft protection and control of anterolateral rotatory instability rather than a major improvement in conventional patient-reported outcome scores.