It’s comeback season! What’s bringing lateral extra-articular tenodesis (LET) back to the landscape of ACL surgery? In this episode of BackTable Bone & Sports, Dr. Larry Balle joins sports orthopedic surgeon and knee specialist Dr. Kyle Borque to discuss the resurgence of lateral extra-articular tenodesis (LET) as an adjunct to ACL repair and reconstruction. They explore LET’s origins as a solution for rotation instability in the era of open ACL surgery, and examine how modern arthroscopic techniques, patient selection, and surgical evidence have driven LET’s renewed relevance in today's practice.

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Timestamps

00:00 - Introduction
02:36 - LET Origin Story
14:16 - Modern LET Technique Updates
23:13 - A Run-Down of the Procedure in the OR
26:54 - Patient Selection for LET
34:18 - Supporting LET with Published Evidence
38:43 - Rehab After LET
44:33 - Dismissing OA Concerns
50:10 - Case Example: ACL Revision
53:02 - Wrap Up

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More about this episode

The Drs. highlight the anatomy considerations, technical modifications, and the evidence that supports LET’s role in reducing graft failure, without changing rehab or increasing lateral OA risk. They compare LET with anterolateral ligament (ALL) reconstruction, emphasizing anatomy and technical approach. Dr. Borque details his modified technique using an iliotibial (IT) band strip fixed proximal and posterior to the lateral epicondyle of the femur. Furthermore, the doctors discuss selection factors for high-risk and revision patients, tactics to avoid overconstraint, and tips for patient counseling. They review the latest evidence, outline perioperative protocols, and address persistent myths about LET’s impact on recovery and osteoarthritis. The doctors highlight a real-world case example and the actionable insights for orthopedic surgeons to optimize ACL outcomes.

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Resources

Dr. Larry Balle
https://www.linkedin.com/in/larry-balle-ii/

Dr. Kyle Borque
https://www.drborque.com/

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/31940222/

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