Anterior Cruciate Ligament Reconstruction With or Without Lateral Extra-articular Tenodesis: A Systematic Review and Meta-analysis of Comparative Outcomes From Randomized Controlled Trials
Orthopaedic journal of sports medicine · 2026
Adding LET to ACLR cuts graft failure and improves pivot-shift control, but does not meaningfully improve patient-reported outcomes or return to sport.
De studie
Systematic review and meta-analysis of 10 RCTs comparing ACL reconstruction with versus without lateral extra-articular tenodesis (LET); pooled patient population size not stated in the abstract.
Wat ze vonden
LET reduced graft failure (log OR -1.19, 95% CI -1.73 to -0.65, P<.001) and improved pivot-shift outcomes (log OR -0.81, 95% CI -1.11 to -0.52, P<.001), with a small Lysholm benefit (mean difference 1.98 points, 95% CI 0.19-3.77, P=.030). IKDC subjective scores are reported inconsistently, an OR of 1.65 with a CI of 0.24-3.05 that excludes zero, but a P value of.22, so that result should be treated as unreliable rather than as a genuine finding either way. No differences were found in KT-1000 laxity, Lachman grade, IKDC objective scores, KOOS subscales, Tegner scores, or return-to-sport rates.
Studieopzet
Systematic review and meta-analysis of randomised controlled trials comparing combined ACL reconstruction plus lateral extra-articular tenodesis against ACL reconstruction alone, pooling comparative outcomes across the included trials in patients undergoing primary ACL reconstruction; the abstract does not state the number of trials or pooled patient total, so the precision behind these estimates can't be independently checked from what's given.
Methodologie
Because only RCTs were pooled, this sits above cohort-based LET literature on the evidence hierarchy, and the tight, low-heterogeneity intervals around graft failure and pivot-shift support real consistency across trials rather than a single outlier study driving the result. But the abstract gives no search strategy, no count or quality grading of included trials, and no risk-of-bias tool, so selection and publication bias can't be ruled out, and inclusion of varied LET techniques and graft types as one pooled group could dilute or exaggerate true effects. Surgeons and patients cannot be blinded to whether a tenodesis was added, which is a plausible source of performance or detection bias for subjective, patient-reported measures, a caveat that fits the unexplained mismatch between the IKDC subjective confidence interval and its P value and is a reason to treat that figure as unresolved rather than reassuring. Funding and conflict-of-interest disclosures for the review are not reported here either, which matters given LET's technique-dependent surgical enthusiasm.
De beoordeling
The graft failure and pivot-shift findings are the strongest signal here, both highly significant with tight, low-heterogeneity confidence intervals, and they line up with what individual trials already suggested. But the patient-reported outcome differences are small, under 2 points on Lysholm, well below any accepted minimal clinically important difference, and objective laxity, KOOS, Tegner, and return-to-sport data show no benefit, so this supports LET as a graft-protection and stability adjunct rather than something that measurably improves how the knee feels day to day.
De beperking
The abstract doesn't report the pooled patient number, the specific LET techniques included, or how risk of bias was graded, and the unexplained P=.22 next to a CI excluding zero for IKDC subjective scores needs resolving before those PROM figures can be trusted.
Referentiestudie
This consolidates evidence from trials such as STABILITY 1 (Getgood et al.), which first showed LET reduces graft rupture risk in young, high-risk ACLR patients with marked pivot-shift laxity, extending that finding across a broader pooled RCT dataset rather than overturning it.
Wat te doen op maandag
This doesn't change what physios or S&C coaches decide, LET selection sits with the surgeon, but it should change what you expect and communicate. For young, high-risk pivoters with marked pivot-shift laxity (the STABILITY-type population), know that LET-augmented knees are statistically less likely to fail and show tighter rotational control on exam, but don't tell the athlete this means a faster or better-feeling recovery: Lysholm gains are trivial and RTS rates aren't different, so RTS testing and criteria should stay exactly as strict as for isolated ACLR.
In practice
For young pivoting/cutting athletes with high-grade pivot shift or hyperlaxity going for revision or high-risk primary ACLR, this is a reason to raise LET with the surgical team, not a reason to change your own rehab template wholesale. In clinic, if LET has been added, respect the surgeon's specific early protocol around terminal extension and combined rotation loading (the lateral tenodesis tissue needs its own healing window), but the mid-to-late stage strength and control work doesn't need to be softer or slower just because the graft is statistically safer. On the S&C floor, don't relax RTS gating for LET-augmented knees: hop symmetry, quad/hamstring LSI, and psych-readiness screening should clear the same bar as any ACLR, since this review found no RTS or PROM advantage, only a lower failure rate. The caveat that matters in practice: the abstract doesn't break results down by LET technique (Lemaire vs MacIntosh vs modified) or by baseline risk profile, so treat the pooled effect as a population-level signal to discuss case-by-case with the surgeon, not a blanket rule for every ACLR patient.
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