Lateral Extra-Articular Tenodesis (LET) with ACL Reconstruction – Are You Adding It?

Lateral Extra-Articular Tenodesis (LET) with ACL Reconstruction – Are You Adding It?

It’s interesting how things can change with time in surgery. LET was actually being performed even before arthroscopic ACL reconstruction became so prevalent. Then arthroscopy took over, and Arthroscopic ACL reconstruction became gold standard. It still is, but LET has definitely made a comeback in the last few years, as an augment atleast.

The rotational stability that an LET provides is theoretically and clinically proven beyond doubt. I wanted to specifically talk about two aspects of LET that is evolving — the indications and the method of fixation.

First, indications. Considering LET has an added advantage, do you add it to every ACL reconstruction? From not being used at all, we’ve come to stage where atleast some indications we agree on definitely could do with that added rotational stability. We had an international consensus statement published last year that clarified some of it atleast (shared in the comments)- Grade 3 pivot shift, knee hyperextension, revision ACLR, Paediatric ACL’s. I definitely agree with all the indications, but I’ve now started using it in even more.

I’ve also been recommending it to all my patients who play any sport, whether is professionally/recreationally, no matter which sport. Cause I don’t necessarily fully agree with the ‘pivoting sports’ indications cause almost any sport with jumping involved can always lead to pivoting on landing. In fact even golf involves pivoting of the knee.

Second, fixation of the LET.
Interference screw? Anchor? Bone Staple? Soft tissue suturing?

I prefer to fix the LET with a bone staple. The time factor is not too significant, but for me the big advantage is not having to worry about femoral tunnel convergence. Sharing an ACL-R + LET done for a professional Kabaddi player.

What are your indications to add an LET in a primary ACLR?
And how are you fixing it?