Available online 20 March 2025, 151159

Graft rupture following ACL reconstruction is one of the major concerns for both patients and providers. Young athletes are the group with the highest risk for reinjury due to the demand they place on the reconstructed ACL. As a result, much consideration has been directed toward reducing the risk of graft rupture. Lateral extraarticular tenodesis (LET) is an adjunct procedure performed along with ACL reconstruction in an attempt to reduce the risk of reinjury. During this procedure, an additional soft tissue structure is constructed on the lateral portion of the knee to reduce residual rotatory instability, which is considered a risk factor for ACL graft rupture. This procedure has been shown in both pediatric and adult cohorts to significantly reduce reinjury rates and has been incorporated into the practice of many pediatric orthopedic surgeons. However, variation exists in the indications for LET, and concerns regarding the addition of a non-anatomical structure to the knee remain, making some surgeons hesitant to adopt this procedure. Promising findings suggest that LET is a strong option to reduce the risk of ACL graft rupture with low risk for additional complications, but more research is necessary regarding this procedure, particularly in pediatric cohorts.

© 2025 The Authors. Published by Elsevier Inc.