LET or Not

References

Every clinical claim on this site traces to one of the sources below. All citations were verified via PubMed (May 2026). Click the PubMed or DOI link to read the original article.

  1. Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020;48(2):285–297.
    PubMed 31940222 · doi:10.1177/0363546519896333
  2. Firth AD, Bryant DM, Litchfield R, et al. Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience. Am J Sports Med. 2022;50(2):384–395.
    PubMed 35050817 · doi:10.1177/03635465211061150
  3. Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI Study Group. Am J Sports Med. 2017;45(7):1547–1557.
    PubMed 28151693 · doi:10.1177/0363546516686057
  4. Heard M, Marmura H, Bryant D, et al. No increase in adverse events with lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction — Results from the stability randomized trial. J ISAKOS. 2023;8(4):246–254.
    PubMed 36646169 · doi:10.1016/j.jisako.2022.12.001
  5. Bosco F, Giustra F, Masoni V, et al. Combining an Anterolateral Complex Procedure With Anterior Cruciate Ligament Reconstruction Reduces the Graft Reinjury Rate and Improves Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2024;52(8):2129–2147.
    PubMed 38353002 · doi:10.1177/03635465231198494
  6. Mao Y, Zhang K, Li J, Fu W. Supplementary Lateral Extra-articular Tenodesis for Residual Anterolateral Rotatory Instability in Patients Undergoing Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med. 2021;9(5):23259671211002282.
    PubMed 33997075 · doi:10.1177/23259671211002282
  7. Lai S, Zhang Z, Li J, Fu WL. Comparison of Anterior Cruciate Ligament Reconstruction With Versus Without Anterolateral Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med. 2023;11(3):23259671221149403.
    PubMed 37025126 · doi:10.1177/23259671221149403
  8. Park YB, Lee HJ, Cho HC, Pujol N, Kim SH. Combined Lateral Extra-Articular Tenodesis or Combined Anterolateral Ligament Reconstruction and Anterior Cruciate Ligament Reconstruction Improves Outcomes Compared to Isolated Reconstruction for Anterior Cruciate Ligament Tear: A Network Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2023;39(3):758–776.e10.
    PubMed 36567183 · doi:10.1016/j.arthro.2022.11.032
  9. Beckers L, Vivacqua T, Firth AD, Getgood AMJ. Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis. J Exp Orthop. 2021;8(1):59.
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  10. Na BR, Kwak WK, Seo HY, Seon JK. Clinical Outcomes of Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis Combined With Primary ACL Reconstruction: A Systematic Review With Meta-analysis. Orthop J Sports Med. 2021;9(9):23259671211023099.
    PubMed 34541008 · doi:10.1177/23259671211023099
  11. Rezansoff A, Firth AD, Bryant DM, et al. Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return-to-Sport Rate to Anterior Cruciate Ligament Reconstruction Alone but a Lower Failure Rate. Arthroscopy. 2023;40(2):384–396.e1.
    PubMed 37270112 · doi:10.1016/j.arthro.2023.05.019
  12. Pioger C, Gousopoulos L, Hopper GP, et al. Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group. Am J Sports Med. 2022;50(13):3493–3501.
    PubMed 36255278 · doi:10.1177/03635465221128261
  13. Sonnery-Cottet B, Haidar I, Rayes J, et al. Long-term Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group. Am J Sports Med. 2021;49(11):2889–2897.
    PubMed 34351825 · doi:10.1177/03635465211028990
  14. Pettinari F, Carrozzo A, Saithna A, et al. Effect of Lateral Extra-Articular Procedures Combined With ACL Reconstruction on the Rate of Graft Rupture in Patients Aged Older Than 30 Years: A Matched-Pair Analysis of 1102 Patients From the SANTI Study Group. Am J Sports Med. 2024;52(7):1765–1772.
    PubMed 38794893 · doi:10.1177/03635465241247760
  15. Rayes J, Ouanezar H, Haidar IM, et al. Revision Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Combined With Modified Lemaire Technique Versus Hamstring Graft Combined With Anterolateral Ligament Reconstruction: A Clinical Comparative Matched Study With a Mean Follow-up of 5 Years From The SANTI Study Group. Am J Sports Med. 2021;50(2):395–403.
    PubMed 34898285 · doi:10.1177/03635465211061123
  16. Sonnery-Cottet B, Saithna A, Blakeney WG, et al. Anterolateral Ligament Reconstruction Protects the Repaired Medial Meniscus: A Comparative Study of 383 Anterior Cruciate Ligament Reconstructions From the SANTI Study Group With a Minimum Follow-up of 2 Years. Am J Sports Med. 2018;46(8):1819–1826.
    PubMed 29741400 · doi:10.1177/0363546518767659
  17. El Helou A, Gousopoulos L, Shatrov J, et al. Failure Rates of Repaired Bucket-Handle Tears of the Medial Meniscus Concomitant With Anterior Cruciate Ligament Reconstruction: A Cohort Study of 253 Patients From the SANTI Study Group With a Mean Follow-up of 94 Months. Am J Sports Med. 2023;51(3):585–595.
    PubMed 36734511 · doi:10.1177/03635465221148497
  18. Getgood A. Avoiding Graft Failure: Lessons Learned from the Stability Trial. Clin Sports Med. 2023;43(3):367–381.
    PubMed 38811116 · doi:10.1016/j.csm.2023.08.005
  19. Getgood A. Editorial Commentary: Indications for Lateral Extra-Articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction. Arthroscopy. 2022;38(1):125–127.
    PubMed 34972553 · doi:10.1016/j.arthro.2021.07.005
  20. Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42(3):641–647.
    PubMed 24451111 · doi:10.1177/0363546513517540
  21. Petit CB, Hussain ZB, Read PJ, et al. Graft Failure Rates in Bone-Patellar Tendon-Bone, Hamstring, and Quadriceps Tendon Autografts in Patients Younger Than 25 Years: A Meta-analysis. Am J Sports Med. 2026 [Epub ahead of print].
    PubMed 41733021 · doi:10.1177/03635465261415842
  22. Lodhia P, Nazari G, Bryant D, Getgood A, McCormack R, et al. Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis. Am J Sports Med. 2022;50(13):3502–3509.
    PubMed 36260487 · doi:10.1177/03635465221128581
  23. Firth AD, Pritchett SL, Milner JS, et al. Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis. Am J Sports Med. 2024;52(4):909–918.
    PubMed 38385189 · doi:10.1177/03635465241228193
  24. Kim SJ, Choi CH, Kim SH, et al. Bone-patellar tendon-bone autograft could be recommended as a superior graft to hamstring autograft for ACL reconstruction in patients with generalized joint laxity: 2- and 5-year follow-up study. Knee Surg Sports Traumatol Arthrosc. 2018;26(9):2568–2579.
    PubMed 29502168 · doi:10.1007/s00167-018-4881-y
  25. Parmar R, Tummala SV, Brinkman JC, Economopoulos KJ. Lateral Extra-Articular Tenodesis With Iliotibial Band in Anterior Cruciate Ligament Autograft Reconstruction for Female Soccer Athletes With Generalized Ligamentous Laxity Yields Graft Failure and Return-to-Sport Rates Comparable With Athletes Without Generalized Laxity. Arthroscopy. 2025;41(10):4136–4144.
    PubMed 40180134 · doi:10.1016/j.arthro.2025.03.045
  26. Sundemo D, Jacobsson MS, Karlsson J, et al. Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2022;30(12):4173–4180.
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  27. Quinn M, Lemme N, Morrissey P, Fadale P, Owens BD. An Update on Emerging Techniques and Considerations in Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev. 2024;12(7).
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  28. Tollefson LV, LaPrade CM, LaPrade RF. Editorial Commentary: Increased Tibial Slope and Decreased Medial Proximal Tibial Angle Negatively Affect Anterior Cruciate Ligament Graft Maturation: Objective Evidence on When to Add a Lateral Extra-Articular Augmentation Procedure to a Soft-Tissue Anterior Cruciate Ligament Reconstruction. Arthroscopy. 2024;41(7):2492–2495.
    PubMed 39580122 · doi:10.1016/j.arthro.2024.11.061
  29. Yamanashi Y, Mutsuzaki H, Iwai K, Ikeda K, Kinugasa T. Failure risks in anatomic single-bundle anterior cruciate ligament reconstruction via the outside-in tunnel technique using a hamstring autograft. J Orthop. 2019;16(6):504–507.
    PubMed 31680741 · doi:10.1016/j.jor.2019.04.015
  30. Webster KE, Feller JA. (See reference 20 above — also reporting contralateral risk and family history data.)
    PubMed 24451111 · doi:10.1177/0363546513517540
  31. Sward P, Kostogiannis I, Roos H. Risk factors for a contralateral anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2010;18(3):277–291.
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  32. Hamad CD, Wiener J, Shahamatdar S, et al. Lateral Extraarticular Procedures Increase Risk of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in Adolescents: A Multi-institutional Propensity-matched Study. J Pediatr Soc North Am. 2026;15:100329.
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  33. Thaunat M, Clowez G, Saithna A, et al. Reoperation Rates After Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction: A Series of 548 Patients From the SANTI Study Group With a Minimum Follow-up of 2 Years. Am J Sports Med. 2017;45(11):2569–2577.
    PubMed 28610433 · doi:10.1177/0363546517708982