Physiotherapy Guide: Lateral Extra-Articular Tenodesis in ACL Repairs
LET is a surgical procedure performed alongside ACL reconstruction to reinforce the lateral side of the knee. It involves using a portion of the iliotibial (IT) band or another graft to create an extra-articular restraint that limits excessive internal rotation and anterior tibial translation. This additional support is especially beneficial for individuals with high-grade pivot-shift injuries or those engaging in high-risk sports such as football, rugby, and skiing.
Why is LET Performed?
While ACL reconstruction alone effectively restores knee function, certain patients remain at risk for persistent instability or graft failure. LET is recommended for:
High-risk athletes: Those who participate in sports requiring intense pivoting and cutting motions.
Patients with high-grade pivot-shift: Individuals who experience significant rotational instability.
Revision ACL surgery: Patients undergoing a second ACL reconstruction due to previous graft failure.
Hyperlaxity: Individuals with naturally loose ligaments who may require additional stabilisation.
Benefits of LET in ACL Surgery
Enhanced Rotational Stability: By reinforcing lateral structures, LET reduces excessive tibial rotation, complementing ACL reconstruction.
Lower Graft Failure Rates: Studies suggest that adding LET to ACL reconstruction may lower re-injury rates, particularly in high-risk individuals.
Improved Post-Surgical Outcomes: LET helps restore normal biomechanics, reducing the likelihood of persistent instability.
Better Long-Term Joint Health: By preventing excessive rotational stress, LET may decrease the risk of osteoarthritis development over time.
Recovery and Rehabilitation
Recovery from ACL reconstruction with LET follows a similar timeline to standard ACL rehabilitation but may involve slightly slower progression in the early phases. Key components include:
Initial Immobilisation and Protection: Limited weight-bearing with bracing for the first few weeks.
Gradual Strengthening: Emphasis on quadriceps, hamstring, and hip muscle activation to support knee stability.
Progressive Loading: Controlled return to running, cutting, and sport-specific drills under physiotherapy supervision.
Return to Sport: Typically occurs between 9–12 months, depending on individual progress and functional assessments.
Conclusion
Lateral Extra-Articular Tenodesis is an effective adjunct to ACL reconstruction for patients at high risk of instability and re-injury. By improving knee stability and reducing graft failure rates, this procedure supports better long-term outcomes and successful return to sport. A structured rehabilitation programme is essential to maximise the benefits of ACL surgery with LET, ensuring a safe and sustainable recovery.
